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Anesthesia for closed chest procedures; needle biopsy of pleura

CPT4 code

Name of the Procedure:

Anesthesia for Closed Chest Procedures; Needle Biopsy of Pleura

Summary

Anesthesia for a needle biopsy of the pleura involves administering medication to ensure the patient is comfortable and pain-free during the procedure. The biopsy itself involves using a needle to collect a small sample of tissue from the pleura, the membrane surrounding the lungs.

Purpose

This procedure is performed to diagnose pleural diseases or conditions such as infections, pleural effusion, or cancer. The goal is to obtain a tissue sample for analysis to guide treatment.

Indications

  • Unexplained pleural effusion (fluid between the lungs and chest wall)
  • Suspicious pleural masses or lesions
  • Persistent pleural pain
  • Diagnosis of pleural infections
  • Staging and diagnosis of pleural cancers

Preparation

  • Patients may be instructed to fast for a certain period before the procedure.
  • Medication adjustments may be necessary, particularly for blood thinners.
  • Pre-procedure tests might include blood work, imaging studies like chest X-rays or CT scans, and pulmonary function tests.

Procedure Description

  1. Pre-Procedure: The patient is positioned appropriately, usually semi-upright or lying on their side.
  2. Anesthesia: Local anesthesia is administered to numb the area, and sometimes mild sedation is given to help the patient relax.
  3. Needle Biopsy:
    • The skin over the biopsy site is cleansed.
    • A needle is inserted through the chest wall into the pleura under imaging guidance.
    • A small sample of pleural tissue is extracted.
  4. Post-Procedure: The needle is removed, and a dressing is applied to the site.

Duration

The procedure typically takes 30 to 60 minutes.

Setting

The procedure is usually performed in a hospital, outpatient clinic, or a specialized surgical center.

Personnel

  • Interventional Radiologist or Pulmonologist (performs the biopsy)
  • Anesthesiologist or Nurse Anesthetist (administers anesthesia)
  • Nurse (assists with procedure and patient care)

Risks and Complications

  • Infection at the biopsy site
  • Bleeding or hemorrhage
  • Pneumothorax (collapsed lung)
  • Pain at the biopsy site
  • Rarely, adverse reactions to anesthesia

Benefits

  • Accurate diagnosis of pleural conditions
  • Guide appropriate treatment planning
  • Non-surgical, minimally invasive approach with rapid recovery

Recovery

  • Observation for a few hours post-procedure to monitor for complications.
  • Instructions on care for the biopsy site.
  • Pain management with over-the-counter pain relief.
  • Follow-up appointments for results and further management.
  • Most patients can resume normal activities within a day or two.

Alternatives

  • Thoracentesis (removal of pleural fluid)
  • Video-Assisted Thoracoscopic Surgery (VATS)
  • Imaging studies like CT or MRI without tissue biopsy
  • Each alternative has its own pros and cons; for instance, VATS is more invasive but may provide more comprehensive diagnostic information.

Patient Experience

During the procedure, patients might feel pressure but should not feel pain due to the anesthesia. Mild discomfort at the biopsy site can be expected after the procedure, which is typically manageable with pain medication. Monitoring and support from healthcare professionals help ensure patient comfort throughout the process.

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