SpecimenIntestinal tissue or cells.
This procedure is contraindicated for
- Patients with bleeding disorders (related to the potential for prolonged bleeding from the biopsy site) or aortic arch aneurysm.
- Assist in the diagnosis of various intestinal disorders, such as lactose and other enzyme deficiencies, celiac disease, and parasitic infections
- Confirm suspected intestinal malignancy
- Confirm suspicious findings during endoscopic visualization of the intestinal wall
Abnormal findings related to
- Celiac disease
- Lactose deficiency
- Parasitic infestation
- Tropical sprue
- Assessment of clear margins after tissue excision
- Classification or grading of tumor
- Identification of malignancy
It is essential that critical findings be communicated immediately to the requesting health-care provider (HCP). A listing of these findings varies among facilities.
Timely notification of a critical finding for lab or diagnostic studies is a role expectation of the professional nurse. The notification processes will vary among facilities. Upon receipt of the critical finding the information should be read back to the caller to verify accuracy. Most policies require immediate notification of the primary HCP, hospitalist, or on-call HCP. Reported information includes the patient’s name, unique identifiers, critical finding, name of the person giving the report, and name of the person receiving the report. Documentation of notification should be made in the medical record with the name of the HCP notified, time and date of notification, and any orders received. Any delay in a timely report of a critical finding may require completion of a notification form with review by Risk Management.
- Barium swallow within 48 hr of small intestine biopsy affects results.
- Failure to follow dietary restrictions before the procedure may cause the procedure to be canceled or repeated.
Nursing Implications and Procedure
- Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
- Patient Teaching: Inform the patient this procedure can assist in establishing a diagnosis of intestinal disease.
- Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to latex or anesthetics.
- Obtain a history of the patient’s gastrointestinal and immune systems, any bleeding disorders, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
- Record the date of the last menstrual period and determine the possibility of pregnancy in perimenopausal women.
- Note any recent procedures that can interfere with test results.
- Obtain a list of the patient’s current medications including anticoagulants, aspirin and other salicylates, herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus). Such products should be discontinued by medical direction for the appropriate number of days prior to a surgical procedure.
- Review the procedure with the patient. Address concerns about pain and explain that a sedative may be administered to promote relaxation during the procedure. Inform the patient that the procedure is performed by an HCP specializing in this procedure and usually takes about 60 min to complete.
- Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
- Explain that an IV line will be inserted to allow infusion of IV fluids, anesthetics, and analgesics.
- Explain that a clear liquid diet is to be consumed 1 day prior to the procedure. Instruct the patient that to reduce the risk of nausea and vomiting, clear liquids have been restricted for at least 2 hr prior to general anesthesia, regional anesthesia, or sedation/analgesia (monitored anesthesia). The American Society of Anesthesiologists has fasting guidelines for risk levels according to patient status. More information can be located at www.asahq.org. Patients on beta blockers before the surgical procedure should be instructed to take their medication as ordered during the perioperative period. Protocols may vary among facilities.
- Provide the patient with a gown, robe, and foot coverings and instruct him or her to void prior to the procedure.
- Instruct the patient to remove dentures. Inform the HCP if the patient has any crowns or caps on the teeth.
- Make sure a written and informed consent has been signed prior to the procedure and before administering any medications.
- Potential complications:
Bleeding (related to a bleeding disorder, or the effects of natural products and medications known to act as blood thinners) or seeding of the biopsy tract with tumor cells
- Ensure that the patient has complied with dietary restrictions.
- Ensure that anticoagulant therapy has been withheld for the appropriate number of days prior to the procedure. Number of days to withhold medication is dependent on the type of anticoagulant. Notify the HCP if patient anticoagulant therapy has not been withheld.
- Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
- Have emergency equipment readily available.
- Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen containers with the corresponding patient demographics, initials of the person collecting the specimen, date and time of collection, and site location.
- Assist the patient into a semireclining position. Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement.
- Record baseline vital signs, and continue to monitor throughout the procedure. Protocols may vary among facilities.
- A local anesthetic is sprayed into the throat. A protective tooth guard and a bite block may be placed in the mouth.
- The flexible endoscope is passed into and through the mouth, and the patient is asked to swallow. Once the endoscope passes into the esophagus, assist the patient into the left lateral position. A suction device is used to drain saliva.
- The esophagus, stomach, and duodenum are visually examined as the endoscope passes through each section. A biopsy specimen can be taken from any suspicious sites.
- Tissue samples are obtained by inserting a cytology brush or biopsy forceps through the endoscope.
- When the examination and tissue removal are complete, the endoscope and suction device are withdrawn and the tooth guard and bite block are removed.
- Monitor the patient for complications related to the procedure (e.g., allergic reaction, anaphylaxis).
- Place tissue samples in formalin solution. Label the specimen, indicating site location, and promptly transport the specimen to the laboratory for processing and analysis.
Esophagogastroduodenoscopy (EGD) Biopsy
- Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.
- Instruct the patient to resume usual diet, as directed by the HCP. Assess the patient’s ability to swallow before allowing the patient to attempt liquids or solid foods.
- Monitor vital signs and neurological status every 15 min for 1 hr, then every 2 hr for 4 hr, and then as ordered by the HCP. Monitor temperature every 4 hr for 24 hr. Monitor intake and output at least every 8 hr. Compare with baseline values. Notify the HCP if temperature is elevated. Protocols may vary among facilities.
- Observe/assess for delayed allergic reactions, such as rash, urticaria, tachycardia, hyperpnea, hypertension, palpitations, nausea, or vomiting.
- Instruct the patient to report any chest pain, upper abdominal pain, pain on swallowing, difficulty breathing, or expectoration of blood. Report these to the HCP immediately.
- Administer mild analgesic and antibiotic therapy as ordered. Remind the patient of the importance of completing the entire course of antibiotic therapy, even if signs and symptoms disappear before completion of therapy.
- Recognize anxiety related to test results. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate. Educate the patient regarding access to counseling services.
- Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
- Instruct the patient in the use of any ordered medications. Explain the importance of adhering to the therapy regimen. As appropriate, instruct the patient in significant side effects and systemic reactions associated with the prescribed medication. Encourage him or her to review corresponding literature provided by a pharmacist.
- Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.
- Related tests include albumin, antibodies gliadin, calcium, cancer antigens, capsule endoscopy, colonoscopy, d-xylose tolerance, fecal analysis, fecal fat, folic acid, iron/TIBC, LTT, ova and parasite, potassium, PT/INR, sodium, US abdomen, vitamin B12, and vitamin D.
- Refer to the Gastrointestinal and Immune systems tables at the end of the book for related tests by body system.