Post Biopsy Management 

There are individual variations in the management of patients following fine needle aspiration biopsy of lung lesions. However, one can make some generalizations:

I routinely do the following:

  1. If the procedure is done with flouro guidance, it is easy to fluoroscope in the same sitting to rule out pneumothorax. If the procedure was done with other forms of localization, I obtain a portable chest x-ray.
  2. I order the following vital signs: pulse, blood pressure and respiratory rate every half an hour for three hours. I instruct the nurse to page me if the respiratory rate suddenly increases.
  3. If there is no pneumothorax, you can stop your close vigilance. It is unlikely for pneumothorax to appear later. If there is pneumothorax and the patient is still asymptomatic, observe him for the next two hours and repeat the chest x-ray (two hour expiratory film).
  4. If all is well, the patient can be discharged with a set of instructions.
  5. Depending on the patient's symptoms and progession of chest x-ray, a next day chest x-ray may be ordered as a further course of action.
The procedure has become relatively safe. The complications are minor and manageable. Many centers have reported the feasibility and safety of the procedure in an out-patient setting. The cost of hospitalization has become a matter of great concern. However, admission be be necessary at times.

I admit patients who are at high risk, cannot tolerate minor complications and in whom immediate medical access is difficult (i.e., elderly feeble patients, patients with severe cardiac or pulmonary disease). Usually, it can be done as an outpatient. The patient should be warned of the possible need for hospitalization after the procedure. They should plan on staying for observation for approximately four hours.