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Prostate Ultrasound and Biopsies (102.142)

Prostate Ultrasound and Biopsies (102.142) - Policies, Clinical, UWMF Clinical, UWMF-wide, Clinical Policies and Procedures, Urologic

102.142

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UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE

TITLE: PROSTATE ULTRASOUND AND BIOPSIES

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

Reviewed November, 2007 April 2010 March 2012


PURPOSE: To provide guidelines for preparation and follow-up care of patients having a prostate ultrasound
or biopsy at UWMF Clinics.

DEFINITION: A prostate ultrasound is used to detect abnormalities of the prostate, such as cancer, begin
tumors or hypertrophy (BPH).

POLICY: The clinical staff will utilize the following guidelines to prepare a patient for a prostate ultrasound or
biopsies.

SUPPLIES: Provider’s order, Patient’s record, Lab slip (labeled) for prostate tissue
2 pair non-sterile gloves, finger cot, o-ring, Large condom
Ultrasound gel, Lubricating gel (in jar), Biopsy guide, Scissors
Disposable biopsy gun /needle OR Reusable biopsy gun with loaded biopsy needle (save needle
package for tissue retrieval)
Ultrasound machine and prostate probe (30cc syringe and tubing with degassed H20),
2 containers formalin and biohazard collection bag
Consent form “Prostate Ultrasound and Prostate Biopsies”
Pad to use in underwear post biopsies

Provider preference :
Local anesthetic prior to biopsies
10cc control syringe, 2 % lidocaine 10cc
22 G 1 ½ needle (or comparable needle)
22G x 6tw chiba needle
Topical anesthetic 10cc Uroject 2% lidocaine jelly
IM antibiotic per MD preference

Room Patient
1. Introduce yourself and identify the patient. Include date of birth.

2. Verify the following with the patient:
Has taken no aspirin, Plavix, ibuprofen, vitamins, or herbs 7-10 days prior
* length of time and items may vary by provider
Has taken no coumadin 4-5 days prior to the procedure
Performed fleets enema that day
Took 1st dose of prescribed antibiotic that A.M.
NOTE: be sure patient understands they are to take 2nd dose of antibiotic at home that evening
(or longer course per MD preference).


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3. Verify patient allergies, specifically to lidocaine and latex

4. Following the provider’s discussion with patient, have patient sign Consent for Procedure and sign
consent form as a witness.

5. Assist or ask patient to undress from waist down

6. Assist or ask patient to lie on exam table on left side with knees bent toward chest.

7. Turn on small light.

Pre-Procedure
1. Verify provider order.

2. Wash hands and gather equipment.

3. Draw up 10cc Lidocaine 2% with 22G 1 1/2 needle.

4. Discard needle in sharp’s container.

5. Attach Chiba needle to Lidocaine syringe.

6. Set up machine and probe using the following procedure:

Probe

1. Place finger cot over probe and then “O” ring per MD preference.

2. Test cot for leaks by filling with degassed water, and remove air bubbles per MD preference.

3. Place large condom over probe with ultrasound gel at tip inside the condom.

4. Insert biopsy guide into probe.

Machine
1. Turn machine on (button is on lower left side of machine).
2. Verify correct MD set up
3. Press ID button to enter name, EPIC #, MD name and press Enter
4. Freeze (snowflake symbol). Press URO key
5. Press F5 report, then F3 PSA. Enter current PSA value. Press enter & unfreeze screen (snowflake
symbol)

6. Press to place biopsy

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7. To remove arrows on screen, press □ and F3
8. Place provider’s gloves on top of machine.
9. Open lubricating jelly jar.

During procedure
1. Wash hands and put on non-sterile gloves.
2. Assist provider by handing Lidocaine (if needed)-- Injectable lidocaine and/or Uroject.
3. Assist provider by handing biopsy gun.

4. Remove tissue samples from needle.

5. Place sample from needle onto pre-labeled paper (labeled “left” & “right”).

6. The provider will indicate which side of the prostate each specimen was removed from. (generally
10 samples)

7. May need to print screens- varies by provider

After procedure
1. Discard needle in sharp’s container.
2. With scissors, cut around tissue sample and place in formalin containers (right and left).
3. Place containers in biohazard bags with lab slips.

4. Assist patient with position and dressing (if needed) after procedure.
NOTE: Observe for vasovagal reaction

5. Patient Teaching
It may be normal to have blood in urine or stools for several days.
Encourage fluids
It may be normal to have blood in semen for next couple of months.
Call the clinic for fever > 101, chills, excessive bleeding.
Provide pad for patient to place in underwear.

After procedure; patient leaves

1. Assist patient with follow-up appointment (if needed).

2. Deliver tissue samples and paperwork to lab.


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3. Clean counters and tables with Dispatch and clean biopsy gun with alcohol.

4. Remove water syringe and tubing from probe, if used.

5. Wipe tubing and water syringe with alcohol and set aside.

6. Using brushes, clean probe and biopsy guide with Metrizyme.

7. Soak in Metricide for 20 minutes, then rinse in sterile water basin.

8. Package biopsy guide in autoclave pouch for further sterilization.

9. Reattach tubing, syringe and return to biopsy machine per MD preference.

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



WRITTEN BY: Deb Brausen, R.N., Manager, Department of Urology
Tracy Ancheta R.N., Department of Urology
Donnette Deuser, R.N., Department of Urology
Gail Jahnke, R.N., N.P., Department of Urology

REVIEWED BY: Donnette Kelly, R.N., Department of Urology, 2012
Carol Decker, RN, MSN, Clinical Staff Educator, 2012

AUTHORIZATION:


Department of Surgery, Urology Date



Medical Director Date