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Policies,Clinical,UWMF Clinical,UWMF-wide,Clinical Policies and Procedures,Dermatology

Punch Biopsy (Sterile or Non-sterile) (102.036)

Punch Biopsy (Sterile or Non-sterile) (102.036) - Policies, Clinical, UWMF Clinical, UWMF-wide, Clinical Policies and Procedures, Dermatology

102.036

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UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE

TITLE: Punch Biopsy
(Sterile or Non-sterile)

Effective Date: October, 2005 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education

Reviewed June, 2008 May 2009 November 2011

PURPOSE: To provide guidelines for set-up and assisting with a punch biopsy at a UWMF Clinics.

DEFINITION: A punch biopsy is a surgical procedure to diagnose or treat problems of the skin. Tissue is
removed from the affected area(s) and sent to the lab for diagnosis. During treatment removing the tissue
removes potentially abnormal cells.
Indications - Inflammatory skin diseases, neoplasm, Lupus, Lichen Planus, Drug Eruptions. Any skin lesion
that a provider wishes a deeper specimen as compared to a shave biopsy.
POLICY: The clinical staff will utilize the following procedure to set-up and assist with a punch biopsy use a
UWMF patient.

SUPPLIES: Provider order, Patient record, Punch, Vaseline, bandage, Forceps, gauze, iris scissors, sutures,
drape, gloves, Lidocaine, Operand prep, Formalin container with patient label, Sterile applicator,
needle holder, Mayo stand (polyback cover for non-sterile procedure, sterile drape for sterile
procedure)

PROCEDURE:
1. Check provider’s order and clarify any inconsistencies.

2. Wash hands and gather equipment.

3. Introduce yourself, identify the patient and provide privacy.

4. Set up equipment on Mayo Stand (with polyback cover or sterile drape)
Forceps, applicator needle holder, scissors, Formalin container with label
Punch and sutures (per provider preference – generally 2-8 mm)
Operand, Vaseline, bandage, gauze, needle holder
Label Formalin container properly for lab

5. Explain procedure to the patient and position the patient per provider request.

6. Wash hands and put on gloves.

7. Prep skin with Operand.

8. Administer prescribed local anesthetic (Lidocaine) to affect areas.
NOTE: (See policy on Injection of Local Anesthetic)


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9. Prepare and drape area for incision as indicated.

10. Assist provider with blotting and cutting of sutures.

11. Provider will place biopsied tissue in container.

12. After biopsy and incision closure, cover site with thin line of Vaseline.

13. When completed, remove gloves and wash hands.

14. Instruct patient regarding wound care. (See Dressing Instruction for Patients).

15. Document in the patient’s record:
Care given to the patient and Vital Signs (if taken)
Post care instructions given to the patient or family
Patient questions or concerns
Future appointment(s) (if needed).

WRITTEN BY: Ronnie Peterson, R.N., M.S., Clinical Staff Educator

CONTRIBUTORS: Jodie Cook, Manager Dermatology
Lisa Hilker, CMA, Department of Dermatology

REVIEWED BY: Lisa Hilker, CMA, Department of Dermatology, 2011
REFERENCES:
1. Pariser (1989) Modern Medicine 57:82-90
2. Snell in Pfeninger (1994) Procedures, p. 20-6
3. Zuber (2002) Am Fam Physician 65(2):2547-58


AUTHORIZATION:


Department of Dermatology Date



Medical Director Date