A liver biopsy in pediatrics is a diagnostic procedure where a small sample of liver tissue is obtained typically using a needle for histopathological examination. It remains the gold standard for diagnosing, staging, and managing a wide range of acute and chronic liver diseases in children.
Indications
- Indian childhood cirrhosis and other cirrhosis
- Hepatitis
- Unexplained hepatomegaly
- Tuberculosis (abdominal)
Equipment Needed
A sterile tray containing:
- Tru-Cut needle or Vim-Silverman needle with the stylet or Menghini needle
- Sterile cotton swab with antiseptic solution
- Procaine 1%
- Syringe with needle
- Sponge holder
- Kidney tray
- Tincture benzoin
- Specimen bottles
- Pair of sterile gloves, gown, and mask
- Center hole towel
Preparation
- Explain the procedure to the parents.
- Obtain a written consent.
- Ensure that the prothrombin time is ascertained; arrange for blood.
- Monitor vital signs.
- Administer sedatives as prescribed.
- Administer injectable vitamin.
Procedure
- Perform hand hygiene.
- Make the child lie on the edge of the table with his hands kept behind the head.
- Clean the area with antiseptic wipes.
- Infiltrate the area with local anesthesia at the level of 10th intercostal space in the midaxillary line (right side).
- Then liver biopsy needle with the stylet is inserted through the 9th or 10th intercostal space or through subcostal approach into the liver tissue.
- Then the stylet is withdrawn, and the split portion is pushed inside the hollow needle.
- It is advanced further into the liver.
- At this stage, the outer needle too is advanced into the liver fully.
- Thereafter, the whole needle is rotated.
- This breaks the liver chip (that is attached to the needle) from the rest of the liver.
- The entire apparatus is withdrawn, and the skin wound is sealed with tincture benzoin.
| Technique | When Used |
|---|---|
| Percutaneous biopsy | Most common; ultrasound-guided; requires normal coagulation |
| Transjugular biopsy | For children with coagulopathy or ascites; avoids puncturing liver capsule |
| Surgical biopsy | During laparotomy or laparoscopy; often when other abdominal procedures are planned |
- Gelfoam® may be inserted into the needle tract to reduce bleeding risk.
- The procedure typically lasts 30–60 minutes, with 2–8 hours of post-op monitoring depending on the setting
Post procedure Care
- Place a cotton pad over the site and turn the child on his right side.
- Place a small pillow under his costal margin and make him remain in the same position.
- Monitor vital signs every 10-15 minutes for first few hours and then half an hourly for first 24 hours.
- Watch for complication of liver biopsy.
- Send the specimen to the laboratory with request form.
- Keep the biopsy site aseptic.
Risks and Safety
- The procedure is generally low risk, but complications may include:
- Bleeding
- Infection
- Gallbladder or lung puncture (rare)
- Contraindications include uncorrected coagulopathy or ascites these may require a transjugular approach instead.
Decision-Making: When and Why
- A liver biopsy is often considered when non-invasive tests (labs, imaging) don’t provide a clear diagnosis.
- It’s especially valuable in:
- Neonatal cholestasis: To differentiate biliary atresia from other causes.
- Unexplained hepatomegaly or elevated liver enzymes.
- Monitoring post-transplant: To detect early signs of rejection or infection.
- Staging chronic liver disease: Such as autoimmune hepatitis or metabolic disorders
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 Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840.
- 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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