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Needle Localization Breast Biopsy (102.124)

Needle Localization Breast Biopsy (102.124) - Policies, Clinical, UWMF Clinical, UWMF-wide, Clinical Policies and Procedures, Surgical

102.124

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UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE

TITLE: Needle Localization Breast Biopsy

Effective Date: February. 2005 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education
Reviewed March 2008 May 2009 November 2011

PURPOSE: To provide guidelines for assisting with performing needle localization breast biopsies on a patient
at UWMF clinics.

DEFINITION: A procedure used to localize abnormal, non-palpable breast tissue that may be difficult to find
during surgery and to remove breast tissue to examine it for the presence of disease.

POLICY: The clinical staff will utilize the following guidelines to properly assist with needle localization
breast biopsies on patients.

SUPPLIES: Sterile “breast biopsy” surgical tray, Cautery/electrode pad, No. 15 blade, Tegaderm/steri-strips,
(provider preference), Local anesthetic, Suture material (provider preference), 10cc syringe, 25G
or 26G needle, Blue specimen container, zinc formalin (with patient from radiology), Betadine or
chloraprep (provider preference), 2 set of sterile gowns, 2 sets sterile gloves, Patient gown,
Chux, Face shield, Provider’s order, Permit for Operation, Patient’s record

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

2. Wash hands and gather equipment.

3. Introduce yourself and identify the patient. Include date of birth. Verify allergies (specifically to Betadine,
Chloraprep, or local anesthetic)

4. Using sterile technique, open surgical tray and place any additional instruments needed on tray and recover
tray until needed.

5. Provide good light and provide privacy by closing curtains and door.

6. Room patient – Refer to Provider Preference List for Rooming Patients.
NOTE: Patient will arrive in office from radiology with a needle wire protruding from the breast for biopsy.
Covering the wire will be a paper cup taped to her breast.

7. Explain procedure to the patient.

8. Following the provider’s discussion with patient, have patient sign Permit for Operation and sign the form
as a witness.

9. Assist patient to the dorsal position and make patient as comfortable as possible.

10. Elevate table and adjust lighting.


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11. Carefully, remove paper cup from patient’s breast.

12. After provider’s examination of the breast, use betadine or chloraprep to cleanse area of breast to be
biopsied. NOTE: Use alcohol if patient is allergic to the other two.

13. Put on disposable gown.

14. Apply electrode pad to patient’s abdomen and attach to electrosurgical generator.

15. Attach cautery to the electrosurgical generator, push power button “on” and place setting per provider
choice.

16. Wash hands and put on sterile gloves and face shield.

17. Assist provider with procedure as needed.

18. After biopsy specimen has been removed, place it in blue container that was brought up from radiology.
DO NOT put Formalin in container. Be sure to confirm that specimen is labeled correctly:
Patient name and date of birth
Specimen type
Date and time of specimen collection
Provider name

19. Place container in a plastic bag, remove gloves and wash hands.

20. Take plastic bag and films to Radiology - Mammography Department.
Radiology will x-ray the specimen to ensure the biopsy was of the abnormality seen on mammogram.
Radiology will place a needle in the specimen and place back into the bag.
The specimen and specimen x-ray will be given back to you.
The remaining films are kept in radiology.

21. Return to General Surgery with the specimen and films. Pour formalin over specimen. Put lid cover on and
bag before submitting specimen to lab.

AFTER PROCEDURE

22. Assist patient to comfortable position.

23. Reinforce postoperative instructions.
Give patient “Caring for incision following Breast Biopsy” handout
Review handout with patient
Assist patient back to waiting room
Assist patient with follow-up appointment (if needed)

24. Complete necessary lab forms

25. Place sticker in Pathology log book.

26. Take labeled specimen container to the lab and film(s) to x-ray.


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27. Apply gloves and clean all surfaces with Dispatch
Bring surgical tray and instruments to dirty utility room
Place needles in sharps containers
Discard waste and disposable equipment in proper receptacles
Wash instruments and tray in dirty utility room
Remove gloves and wash hands
Bring instruments to clean utility room

28. Wrap surgical tray and instruments for sterilization.

29. Documentation (in Progress Notes section of HealthLink) in the patient’s record:
Patient education
Procedure performed, date & time completed
name and amount of any medications given (using SmartPhrase: .medinclinic)
how the patient tolerate the procedure
discharge instructions and follow-up appointment (if any)

WRITTEN BY: Kelly Barman, R.N., Department of General Surgery

REVISED BY: Carol Decker, RN, MSN, Clinical Staff Educator

REVIEWED BY: Kelly Meyer R.N., Department of General Surgery

REFERENCES:
Kowalak, J. P. (Ed.). (2009). Lippincott’s nursing procedures (5th ed.). Ambler, PA: Lippincott Williams &
Wilkins.
Perry, A.G. & Potter, P.A. (2002). Clinical nursing skills & techniques. (5th ed.). St. Louis, MO: Mosby.
Perry, A.G. & Potter, P.A. (2009). Fundamentals of nursing. (7th ed.). Hall, A. & Stockert, P.A. (Eds.). St.
Louis, MO: Mosby Elsevier.

AUTHORIZATION:



Department of Surgery Date



Medical Director Date