Procedural tips

[Tn Family MD]

I have an endometrial biopsy scheduled in my clinic on Monday. I have never done one though I have seen a few. Anyone that has any tips on how to make it go as smoothly and successfully as possible, please share your knowledge.

I guess this could go for any procedure that you have a good tip for, but specifically today I am interested in the endometrial biopsy. Thanks.

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[deleted87716]

If possible, read the chapter in Pfenninger's "Procedures for Primary Care Physicians."

Short of that, here's an overview of the procedure from AFP: http://www.aafp.org/afp/20010315/1131.html

Personal tips:

I've found it helpful to premedicate patients with 800mg of ibuprofen, assuming no contraindications. Have them take it at home before they come to their appointment. It helps a lot with cramping.

Definitely use your uterine sound and/or dilators. I've seen people in a hurry try to skip that part, and regret it. You can't force the biopsy catheter.

It's a pretty simple procedure. Good luck!

 

[drwatson]

As a medical student I can offer these simple tips:

1-Always, Always, ALWAYS double glove before a rectal exam
2-Drain the ballon *before* you pull out the foley

More to follow...

 

[Tn Family MD]

Thanks, Kent. I read the Bible...I mean Pfenninger's (love the foreword by Dr. Rodney, one of the physicians I most highly respect in all the world). It did not mention dilation unless I completely overlooked it. Is this necessary, or can it be done without it comfortably? I don't recall ever having seen this done on any of the EMBx's I have seen performed, but maybe I was just spaced out during that part of the procedure. If it matters, this is a woman in her mid-50's that is multiparous.

Also, for everyone else, don't forget to post useful nuggets of wisdom for other procedures as well.

 

[deleted87716]

It did not mention dilation unless I completely overlooked it. Is this necessary, or can it be done without it comfortably?

Generally, if you can pass the sound, you can pass the biopsy catheter. Use the dilators only if you initially have difficulty passing the sound.

Hope this helps!

 

[raptor5]

KentW, do you ever premedicate w/ a benzo for relaxation/anxiety?

 

[deleted87716]

KentW, do you ever premedicate w/ a benzo for relaxation/anxiety?

Nah...a martini usually does the trick.






...KIDDING!!!

 

[lowbudget]

For you or the patient?

 

[deleted87716]

For you or the patient?

Seriously, though...I don't routinely give benzos before any procedures that I do, except in rare circumstances (particularly nervous patient with transportation).

As for the martini, that's more helpful after work.

 

[Faebinder]

It is a service industry after all... shall we start making the front desk pass martinis and margaritas?

 

[ntubebate]

Have used Ativan in maybe 10% of patients.


I do however give an RX for Naprosyn 500mg 1 tab PO q2hrs before proceedure, as well as Tylenol #3, 1 tab PO q2hrs before proceedure.

Driver always required. The T#3 really helps and calms a lot of the boarderline anxiety involved.

That said, I am from the school of thinking that believes you should use all measures availble to make a patient comfortable for any proceedure.

ntubebate