Definition
Assisting with a renal biopsy the removal of kidney tissue for diagnostic analysis is a high precision nursing responsibility that demands sterile technique, patient safety, and vigilant monitoring.
Purposes
- To diagnose cause of glomerulonephritis.
- To diagnose renal malignancy.
- Prior to renal transplantation.
- To evaluate rejection response in renal transplant patient.
- To determine prognosis of renal disease.
Types of Renal Biopsy
| Type | Access Route | Indications |
|---|---|---|
| Percutaneous | Through skin (ultrasound- or CT-guided) | Most common; native or transplant kidney |
| Transjugular | Via jugular vein to renal vein | For patients with bleeding risk or obesity |
| Open Surgical | Direct visualization during surgery | Rare; used when percutaneous is contraindicated |
Contraindications
- Single functioning kidney.
- Malignant tumors.
- Hydronephrosis.
- Pregnancy.
- Coagulation disorders.
Articles
Kidney biopsy set containing the following:
- Artery clamp.
- Surgical towels (2).
- Gallipot with cotton balls.
- Kidney tray.
- Sterile tru-cut needle (biopsy needle).
- Scalpel blade 3/11 with holder.
- Slit towel.
A clean tray containing the following:
- 1. 5 cc syringe.
- Disposable needles: 22 g (1) and 20 g (2).
- Iodine, spirit, or other antiseptic solution.
- 2% xylocaine.
- Sandbag or firm pillow.
- Broad adhesive.
- Gloves (2 pairs).
- 10% formalin in small bottle.
- 0.9% saline (normal saline).
- Disposable plastic aprons.
- “Sharps” container.
- Urine specimen containers (3).
Other articles
- Portable USG machine.
Preparation
Preparing for a renal biopsy involves several important steps to ensure the procedure is safe and effective:
- Medical History Review:
- Inform your healthcare provider about any medications, supplements, or herbal remedies you are taking, as some may increase the risk of bleeding.
- Disclose any medical conditions, such as bleeding disorders, high blood pressure, or diabetes.
- Medication Adjustments:
- Stop taking blood-thinning medications like aspirin, ibuprofen, or anticoagulants as advised by your doctor, usually a week before the procedure.
- Fasting:
- You may be asked to avoid eating or drinking for several hours before the biopsy.
- Pre-Procedure Tests:
- Blood and urine tests may be conducted to check for infections or other conditions that could affect the biopsy.
- Clothing and Preparation:
- Wear comfortable, loose-fitting clothing and remove any jewelry or metallic items.
- The biopsy site may need to be cleaned and shaved.
- Consent and Communication:
- Read and sign the consent form, and discuss any concerns or questions with your healthcare provider.
Procedure
| Nursing action | Rationale | |
| 1. | Explain the procedure and obtain informed consent. | Promotes patient cooperation and prevents legalities. |
| 2. | Ensure that X-ray films, IVP results, and bleeding parameters are available before the procedure. | Obtains baseline data to determine treatment guidelines. |
| 3. | Assemble equipment on trolley in treatment room. | Saves time, material, and energy. |
| 4. | Assist patient to lie in prone position and place sandbag or firm pillow under abdomen. | Provides access to biopsy site. |
| 5. | Physician locates the position of kidney under USG guidance and the site is marked. | |
| 6. | The site is prepared by cleaning with povidone iodine and 70% alcohol. | Minimizes chances of introducing microorganisms in body cavity. |
| 7. | Assist in administering local anesthetic to the patient. | |
| 8. | Assist in making small stab incision through skin and inserting biopsy needle. | |
| 9. | Ask patient to take a deep breath and to hold it while biopsy is being taken. | Avoids chances of injury to adjacent organs. |
| 10. | Reassure patient while physician removes needle and applies pressure bandages. | Pressure over incision site prevents bleeding. |
| 11. | Turn patient to supine position slowly and make him comfortable. | |
| 12. | Preserve biopsy specimen in formalin bottle, place label, and send to laboratory. | |
| 13. | Replace equipment. | |
| 14. | Document time of biopsy, success of the procedure, patient condition, and vital signs. |
Postprocedural care
- After half an hour, transfer patient from treatment room to bed or stretcher.
- Explain to patient about strict bed rest for 24 hours and the need to avoid coughing or sneezing.
- Check vital signs, BP, pulse, and respiratory rate every 15 minutes for first hour; every half an hour for next 2 hours and every hour for the next 3 hours.
- Instruct patient to drink at least 2,000-3,000 mL of fluid in next few hours.
- Give three small labeled bottles to collect first three urine specimens.
- Inform doctor in case of gross hematuria, drop in blood pressure, rise in pulse rate, abdominal pain, and any unusual symptoms.
- Check biopsy site for bleeding. Assess for tightness of adhesive and do the needful.
Special Consideration
- Ensure the patient has followed all preparation instructions, such as fasting and stopping certain medications.
- Address any anxiety or concerns the patient may have by explaining the procedure clearly and reassuring them.
- Observe the patient for signs of discomfort or complications, such as bleeding or pain.
- Ensure sterile techniques are followed to minimize the risk of infection.
- Monitor the patient for complications, such as excessive bleeding or changes in vital signs.
- Provide instructions for rest and recovery, including avoiding strenuous activities for a specified period.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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