@gianni Patient Education and Consent
Most education initially includes indications for bone biopsy in the case, potential complications, and benefits from the result that will guide appropriate treatment.
Explain the nature of the procedure. The patient should be instructed to fast before the procedure because moderate-to-deep intravenous (IV) sedation might be required as well as local anesthesia at the side of biopsy.
Instruct the patient to take tetracycline and avoid certain diets, in case dynamic histomorphometry is planned after tetracycline double-labeling.
Advise the patient undergoing peritoneal dialysis (PD) not to have a day dwell of PD fluid on the day of the biopsy. Suggest to the relatively dehydrated postdialysis patient that the dialysate dextrose concentrate should be decreased on the night before the biopsy to prevent hypotension.
Most patients can go home on the same day of the biopsy except for selected cases, such as elderly or sick patients who might require an overnight stay.
Determine platelet counts and coagulation function. Thrombocytopenia and coagulopathy can potentiate bleeding after the procedure. Determine blood urea nitrogen (BUN) and serum creatinine. Renal failure can cause platelet dysfunction and increase the risk of bleeding.
Patient Preparation
Anesthesia
A combination of analgesia (fentanyl) with either sedation (propofol infusion) or a benzodiazepine (midazolam) has resulted in excellent biopsy conditions and rapid recovery. Local anesthesia should be used to decrease procedural stimulation and provide some postprocedure pain relief.
Positioning
In current practice, transiliac bone biopsy can be performed with the patient in either of the following two positions:
Supine
Lateral decubitus (left lateral decubitus for a right iliac crest biopsy, right lateral decubitus for a left iliac crest biopsy)
Monitoring & Follow-up
Vital signs should be monitored. Pulse oximetry and continuous cardiac monitoring are warranted in moderately sedated or deeply sedated patients.
After the procedure, the patient should be advised to maintain bed rest for 3-6 hours, mainly to allow the effects of the sedation to wear off. The patient can then get out of bed and go home the same day, except in selected cases where overnight monitoring is required.
At 24 hours after the biopsy, the patient should be instructed to remove the pressure dressing and replace it with a small adhesive pad. After 48 hours, the patient can shower, clean the incision site with soap and water, and then cover the site with a small adhesive pad.
At 7-10 days after the procedure, the sutures can be removed. The patient should be advised to watch for potential complications (eg, bleeding, hematoma, or skin infection).