Liver biopsy needles and procedures —

Liver biopsy needles

1. Menghini’s aspiration biopsy needle

2. Vim-Silverman cutting needle.

Precautions in Liver biopsy

• Bleeding time should be within normal limits.
• Vein should be patent and blood should be arranged Hydatid cyst, subphrenic abscess, bleeding tenden­cies should be ruled out.
• Patient should be sedated.

Vim-Silverman liver biopsy needle

liver biopsy needle

• (It has 3 parts) It consists of a long sharp needle, a stilette, prong, or fork which is longer than the needle so that it pro­trudes out of the needle when inside the needle. Both the fork and the stilette fit inside the needle nicely.
• The fork or prong has very sharp cutting edge. There is no guard on this needle.

Site of puncture —

• Anterior or midaxillary line 2 spaces below the upper edge of liver dullness during full expiration i.e. 9^th or 10^th right intercostal space.

Procedure of liver biopsy —

Procedure of liver biopsy

 

• Patient should hold the breath in full expiration.
• The site of puncture is infused with local anaesthetic into the skin.
• The needle is thrust into the liver 2-3 cm deep at the puncture site. The stillete is removed and the prongs are inserted. The prong which projects out of the needle is rotated through 360⁰ so as to remove a portion of liver tissue between the prongs.
• The tissue is sent for histopathological examination.

Complications of liver biopsy

• · Pleurisy
• · Perihepatitis
• · Intraperitoneal or intrathoracic haemorrhage
• · Intrahepatic hematoma
• · Biliary peritonitis
• · Pulmonary bile embolism
• · Bacteremia.

RENAL BIOPSY Indications

• · Nephrotic syndrome
• · Acute renal failure
• · Undiagnosed proteinuria
• · Hematuria
• · Nephritic syndrome
• · Systemic diseases with renal failure.

biopsy Instrument —

• · Vim – Silverman’s biopsy needle
• · Menghini’s biopsy needle.

Method —

• · Bleeding and clotting time should be normal.
• · Blood pressure should be controlled.
• · Plain X-ray abdomen is taken.
• · Sedate the patient.
• · The patient lies on his belly with a pillow under his abdomen.
• · A puncture is made with the Vim – Silverman’s needle on a line between the anterior end of 11 th rib and 2^nd lumbar vertebra at the back on the right side.
• · The right side is preferred because of lower po­sition of kidney and because the great vessels are on the left side.
• · The part is cleaned and draped. Local anaesthetic is infiltrated. A small nick is made and puncture needle is introduced into the kidney. When the needle enters the kidney it starts moving in a wide arc with respiration.
• · The stilette is removed and prong is introduced into the renal parenchyma. The prong is ad­vanced till it enters the kidney tissue, it is then rotated in a circle and taken out along with the needle.
• · The patient is asked to remain on his back for 12 hours and drink a lot of water to prevent clot formation.

Complications

• · Retroperitoneal haemorrhage
• · Hematuria
• · Pain in loins.