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Prostate Biopsy - Urology Clinic (12.52)

Prostate Biopsy - Urology Clinic (12.52) - Policies, Clinical, UWHC Clinical, Department Specific, Ambulatory, Clinic Specific

12.52

12.52 Prostate Biopsy ‐ Urology Clinic  
Category:  UWHC Departmental Policy   
Policy Number:  12.52    
Effective Date:  March 20, 2013   
Version:  Revision    
Manual:  Ambulatory    
Section:  Clinic Specific (Ambulatory)   
 
 

I. PURPOSE

Describe the steps to prepare a patient and to assist with the prostate biopsy procedure. The
procedure is done under the guidance of ultrasound.

II. POLICY

Urology Procedure Area Registered Nurse, Medical Assistant or Radiology Technician will prepare
the patient for a transrectal prostate biopsy, assist the physician with the procedure, provide post
procedure care, and provide the patient with discharge instructions.

III. EQUIPMENT
1. Ultrasound machine with transrectal probe
2. Large probe cover
3. Biopsy needle guide
4. Biopsy needle
5. 2 pair of examination gloves (non-sterile)
6. 2 bottles of 10% formalin
7. 1 Telfa pad 3x4 inches
8. 1 pack of 4x4's
9. 18 gauge needle
10. Lubricant
11. 1 sterile drape
12. 2 patient labels
13. Tissue exam request form (pathology request form)
14. Aquasonic gel for the ultrasound machine

IV. PRE-PROCEDURE

A. Pre-procedure teaching is completed by telephone by the Registered Nurse (RN) after
the patient has been scheduled for the biopsy. The RN will discuss the basics of how the
procedure is conducted by the physician, what the patient may experience and how the
patient will be supported. Using Health Facts For You (HFFY) #4812, instruct patient on
bowel preparation, pre- and post-procedure antibiotics, anti-coagulant guidelines, and
pre-procedure urinalysis as ordered by physician. Document the patient learning
assessment, what was taught and how the patient responded.
B. Prepare the ultrasound machine and enter the patient's name, medical record number,
date of birth, and physician name, and set up the equipment before the patient is

brought into the room.
1. Using sterile technique, the staff will set up a tray for the physician with the
following supplies on a sterile drape opened flat:
a. 1 pack of 4x4's with lubricant
b. 18 gauge needle
c. Telfa pad 3x4
d. Disposable biopsy needle
C. The staff will prepare the transrectal probe with a large probe cover filled with aquasonic
gel.
D. When the patient arrives:
1. Verify patient identity using two patient identifiers.
2. Obtain a mid-stream urine sample for urinalysis, per Ambulatory Policy 12.58 –
Obtaining Urine Specimens on Day of Visit Policy, completed prior to the
procedure and review results.
a. If the results show no bacterial growth, proceed with the procedure
preparation.
b. If the results are positive for bacterial growth, contact the
physician. The physician may decide to go ahead with the procedure.
E. Obtain a brief health history including allergies, medication reconciliation and
measure vital signs. Check if the patient has followed the prescribed course of pre-
procedure antibiotics and bowel preparation and assess if currently taking any
anticoagulants. If the patient reports he has taken any anticoagulants in the past week,
alert the physician and procedure may be postponed.
F. Record information, including the time of the prophylactic antibiotic in HealthLink using
the Health Link smart phrase: uroantibx.
G. Consent for the procedure is obtained by the physician and documented on
UWHC Consent Form #1289139 prior to the procedure.
V. PROCEDURE

A. The staff will instruct the patient to undress from the waist down and lie on the left side
on the exam table. Place a pillow between the patient’s knees and instruct the patient
to flex knees upward toward the chest. Cover the patient with a half sheet. The
physician will be notified that the patient is ready for the procedure.
B. Complete pre-procedure time-out and document in the patient's electronic medical
record.
C. The physician will begin the procedure by performing a rectal exam and palpating the
prostate.
D. After each biopsy, the physician will place the prostatic tissue on the Telfa pad. The
assistant will place the tissue into the labeled formalin container. All tissue should be
placed in the appropriately labeled formalin container noting right side and left side
prostate samples. The specimens will be labeled with two patient identifiers in the
presence of the patient and verified per Clinical Laboratories Policy 5.06. Specimens will
be sent to pathology for analysis.

VI. POST-PROCEDURE

A. Obtain post-procedure vital signs, pain, condition and response to the procedure. Notify
the RN or physician of significant abnormal findings.
B. The patient will remain in the Urology Procedure Area until he has voided and provided a
clear urine sample free of clots or with minimal to no visible hematuria. Offer
fluids. The staff will review discharge instructions with patient including a reminder to
take post-procedure antibiotic and patient to call if he has fever or bleeding or problems
voiding. Provide HFFY #4812 with clinic contact phone numbers.
C. Equipment Cleaning Post Procedure
1. Transrectal Ultrasound Probe Cleaning - Using gloves and standard precautions,
the probe covers are removed from the probe and discarded.
2. All instruments are sent to reprocessing.

VII. REFERENCES


Ambulatory Policy 12.58 - Obtaining Urine Specimens on Day of Visit Policy
Clinical Laboratories Policy 5.06 - Acceptance Policy for Specimen Identification
Health Facts For You (HFFY) #4812

VIII. REVIEWED AND APPROVED BY

Ambulatory Policy and Procedure Committee
Urology Clinic Manager
Infection Control
Clinics Administration

SIGNED BY

Deborah D. Tinker, MSN RN CENP, Director, Ambulatory Nursing