One-hour Recovery Time in Subjects Undergoing Percutaneous Liver Biopsy: A Quality Improvement and Patient Safety Project
One-hour Recovery Time in Subjects Undergoing Percutaneous Liver Biopsy: A Quality Improvement and Patient Safety Project
复制标题
DOI：
10.7759/cureus.5799
复制
发表时间：
2019-09-29
影响因子：
1.2
通讯作者：
Morales-Cardona, Amilcar L.
中科院分区：
文献类型：
--
作者：
Liane, Billy-Joe;Dooley, Guy;Morales-Cardona, Amilcar L.
简介肝活检是诊断、分期和指导肝病临床治疗的金标准。目前尚无肝活检恢复时间的标准指南。该项目的目的是研究经皮肝活检后一小时恢复时间的安全性，并测量并发症发生率并识别危险因素。 方法 2016 年 12 月至 2018 年 10 月期间，连续纳入 500 名在单中心教学机构（布鲁克陆军医疗中心）接受经皮肝活检的受试者。活检使用 14 号 Bard (R) Monopty (R) 核心活检针进行，使用床旁超声检查。并发症定义为：疼痛等级 > 5 分（满分 10 分）、住院、急诊室就诊或其他。主要并发症定义为：住院和急诊就诊。结果唯一需要住院的并发症是在康复的第一个小时内发现的。与体重指数 (BMI) 低于 30 kg/m(2) 的患者相比，体重指数 (BMI) >= 35 kg/m(2) 患者的肝活检与更多并发症无关。与标准 1.5 英寸针相比，使用脊椎针 (3.5 英寸) 麻醉皮下组织过多的受试者的肝包膜并不会导致更多并发症。仅接受利多卡因进行活检的患者中，只有 3% 需要术后药物治疗。 结论 使用 14 号针进行超声引导下经皮肝活检总体上是安全的。恢复后一小时足以识别所有直接的主要并发症。
IntroductionLiver biopsy is the gold standard in diagnosing, staging and guiding clinical management in liver disease. There are currently no standard guidelines for liver biopsy recovery time. The aims of this project are to study the safety of a one-hour recovery time after percutaneous liver biopsies and to measure the rate of complications and identify risk factors.MethodsA total of 500 consecutive subjects who underwent a percutaneous liver biopsy at a singlecenter teaching institution (Brooke Army Medical Center) were enrolled between December 2016 and October 2018. Biopsies were performed using a 14-gauge Bard (R) Monopty (R) core biopsy needle using bedside ultrasound. Complications were defined as: Pain level > 5 out of 10, hospitalizations, emergency department visits, or other. Major complications were defined as: hospitalizations and emergency department visits.ResultsThe only complication that required hospitalization was identified during the first hour of recovery. Liver biopsies of subjects with body mass index (BMI) >= 35 kg/m(2) were not associated with more complications when compared to patients less than 30 kg/m(2). Using a spinal needle (3.5 '') to anesthetize the liver capsule in subjects with excess subcutaneous tissue did not result in more complications when compared to the standard 1.5 '' needle. Only 3% of the patients who received lidocaine alone for the biopsy required post-procedure medications.ConclusionUltrasound-guided percutaneous liver biopsies, using a 14-gauge needle, were overall found to be safe. A one-hour post recovery period is adequate to identify all immediate major complications.