Liver Biopsy: Comprehensive Protocol and Best Practices

Pre-Procedure Requirements

Patient Preparation

• Obtain informed consent
• Review recent coagulation profile (INR < 1.5)
• Platelet count > 50,000/μL
• NPO for 6 hours prior to procedure
• IV access establishment

Equipment Checklist

• Ultrasound machine with sterile cover
• Biopsy needle (16-18 gauge)
• Local anesthetic (1-2% lidocaine)
• Sterile drapes and equipment
• Specimen containers with formalin

Procedure Steps

1. Initial Assessment

• Verify patient identity and consent
• Review imaging to identify optimal biopsy site
• Mark entry point under ultrasound guidance

2. Sterile Technique

• Perform surgical hand scrub
• Don sterile gown and gloves
• Prepare skin with chlorhexidine/betadine

3. Biopsy Execution

1. Infiltrate local anesthetic
2. Make small skin incision
3. Advance biopsy needle during patient's held expiration
4. Obtain tissue sample (minimum 2cm length)
5. Apply pressure to biopsy site

4. Post-Procedure Care

• Monitor vital signs q15min for 2 hours
• Maintain right lateral decubitus position
• Observe for complications

Documentation Requirements

Essential Elements

• Procedure note with technique details
• Specimen handling instructions
• Post-procedure orders
• Patient education provided

Complications Management

Monitor for:

• Bleeding
• Pain
• Hypotension
• Pneumothorax

Emergency Protocols

• Emergency response team contact information
• Management algorithms for complications
• Transfer protocols if needed