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taken. Nursing staff should review bloods as part of their preprocedure assessment. If a patient is currently taking an anticoagulant such as warfarin, a clotting sample must be taken within 24 hours of the procedure. Medications should be reviewed by medical and nursing staff and arrangements made by the medical team for alternative anticoagulant and diabetic medication if necessary. A local anaesthetic such as lidocaine 2% is infiltrated into the area where the biopsy is to be taken. In some cases where the patient is extremely anxious, conscious sedation may be considered; however, management during and after the procedure would include physiological monitoring and recovery as in colonoscopy with conscious sedation (Al Knawy and Shiffman 2007).

Specific patient preparations

A baseline set of physiological observations must be undertaken. If conscious sedation is used the patient must be nil by mouth and they must have patent IV access (Royal College of Radiologists 2006). The patient is usually in the supine position with the right side as close to the edge of the bed as possible. The left side may be supported by a pillow. The patient’s right hand is positioned under their head and their head turned to the left. Oxygen therapy may be required if there are pre-existing conditions or when conscious sedation is used.

Postprocedural considerations

Immediate care

Immediately following the procedure the patient must lie on their right side for 3 hours and remain on bed rest for a total of 6 hours. They may be able to go to the toilet after 3 hours. Physiological observations are required every 15 minutes for the first hour, every 30 minutes for the following 2 hours and then the frequency can be reviewed by the registered nurse. Any abnormality must be reported to the medical team immediately. The nurse should also observe the puncture site and abdomen for signs of bleeding and ensure that pain is adequately controlled.

Ongoing care/education

A postprocedure information sheet should be given to the patient identifying possible complications and instructions on what to do if any symptoms occur (Royal College of Radiologists 2006).

Complications

Haemorrhage

An inadvertent puncture of an intrahepatic or extrahepatic blood vessel can lead to haemorrhage manifesting within 4 hours. However, it is normal to lose approximately 5–10 mL of blood from the surface of the liver after the biopsy. Conservative management with blood products may be appropriate but surgical intervention may also be required to treat haemorrhage.

Peritonitis

An inadvertent puncture of the bile duct which consequently results in bile leaking into the peritoneal cavity can lead to peritonitis. Treatment may range from antimicrobial therapy to surgical and/or critical care intervention dependent on the severity.

Pneumothorax

An inadvertent puncture of the pleura can lead to a pneumothorax. If this occurs, urgent medical intervention is required. A formal chest drain may be necessary to relieve the pneumothorax (Denzer et al. 2007, Thampanitchawong and Piratvisuth 1999).

Radiological Investigations: X-ray

Definition

An X-ray is a short-wavelength electromagnetic radiation that passes through matter and is used in diagnostic radiology and radiotherapy (Martin 2010).

Evidence-based approaches

Rationale

The general X-ray department performs a wide range of examinations many of which require no patient preparation in advance, and can often be performed on the day of the request. In accordance with the Ionizing Radiation Regulations (1999), to ensure radiation safety, there is a requirement for radiographers to justify, optimize and limit radiation dosage to a patient.

Indications

Diagnostic X-rays are performed to diagnose medical conditions such as damage to the skeletal structures and organ dysfunction, for example chest X-rays for respiratory complications.

Contraindications

The Ionizing Radiation (Medical Exposure) Regulations (2000) (Regulations 6 and 7) prohibit any medical exposure from being carried out which has not been justified