Perioperative Nursing Care of Ambulatory Breast Biopsy Surgery

【Major points】

Ambulatory breast biopsy surgery is under local anesthesia around the surgical site, take samples with a blade or a thick needle, send the breast tissue for pathological examination, suture the wound, and discharge from hospital.
On the day of surgery, you need to bring your health insurance card, surgery notice, surgery consent form, anesthesia consent form and other outpatient documents to check into the operating room.
Pre-operative preparations: go to the toilet, remove clothing and accessories, put on surgical gowns, and remove nail polish.
Instruction during operation: do not touch surgical site and maintain the position, do not move at will.
The wound should be kept dry after surgery, and wound care should be performed following doctor's instructions.

What is the ambulatory breast biopsy surgery?

In the operating room, the surgeon injects local anesthetics around the suspected breast lesions by scanning with an ultrasonic probe. After confirming pain free around anesthesia injection site, a blade or a thick needle are used to obtain breast tissue for further pathological examination. After the procedure is completed, check bleeding of the surgical wound, then close the surgical wound and cover with gauze. After ambulatory breast biopsy surgery is done, and without physical discomfort, you can go home without hospitalization.

The purpose of the ambulatory breast biopsy surgery:

Upon registration to the end of surgery, regarding your condition registered nurse will provide individual nursing care, keep you warm, privacy and safety during your procedure.

Pre-operation preparation and nursing
On the day of surgery, bring the health insurance card, operation notice, operation consent form, anesthesia consent form, and other outpatient documents to the operating room.
1. Confirm the surgery information
  When you enter the operating room, in order to performing accurate surgery, different medical staff will repeatedly ask your name, birthday, and location and procedure of the operation to confirm all information is consistent with the intended operation.
2. Preparation for Local Anesthesia
  Ask about your medicine history, allergies, and whether you have a history of hypertension and asthma, as a reference for monitoring vital signs during surgery.
3. Going to the toilet
  When you hear the announcement entering the operating room, please urinate before entering the operating room.
4. Change into surgical gown
  You must change into surgical gowns before entering the operating room. Personal clothing including underwear and socks are not allowed.
5. Remove accessories
  Electric coagulation is used to stop bleeding during the operation. To avoid electric burns, metal objects and accessories such as glasses, hairpins, necklaces, rings, amulets, etc. must be removed from the body before entering the operating room.
Intra-operation preparation and nursing
1. Warmth and Privacy
  Body exposure will be minimized during the procedure; according to body temperature and warming needs, inflatable thermal equipment or warming blankets will be given.
2. Disinfection of the surgical site
  The surgical site and surrounding area will be washed with warm water then disinfected with tincture and alcohol. During disinfection, there will be a cold feeling. Please do not touch the disinfection area with your hands to avoid wound infection after surgery.
3. On the skin of calf or a large muscle area, the electrocautery hemostasis circuit is pasted to use electronic coagulation to stop bleeding during surgery.
4. Laying a sterile drape over the surgical site
  To avoid surgical site infection, place a sterilized sheet around the surgical site. The cloth, covering the face sheet will be opened after the surgeon completes the laying of the sheet.
5. Administration of local anesthesia
  Use a smaller needle to inject anesthesia around the surgical site to reduce pain during surgery. During the operation, having sensation of touch and pull is normal. If you feel pain at the surgical site, please notice the medical staff at any time to increase the administration of local anesthetics.
6. Under ultrasonic scanning to confirm the location of breast, you will feel the pushing of the ultrasonic probe and the cold feeling of the gel.
Post operation nursing
1. Body cleansing
  To avoid wound infection and affect wound healing, the sutured wound should not touch water within 3-7 days, please clean the body by bathing. If there is a need to shower, apply a waterproof dressing to the wound before showering. Do not take a bath until the wound is fully healed.
2. Wound Care：https://ihealthen.vghtpe.gov.tw/media/109

Home care notifications:

If the wound has active bleeding, odor, purulent discharge, or fever over 37.5°C, please return to the hospital for the treatment.
Return visits
According to the appointment date of the surgeon, go to the outpatient clinic to check the condition of the wound, remove the sutures, and confirm the pathology examination result.

Reference

Akın M. E. (2021). Effect of music on anxiety and pain during ultrasound-guided core needle breast biopsy: a randomized controlled trial. Diagnostic and interventional radiology (Ankara, Turkey), 27(3), 360–365. https://doi.org/10.5152/dir.2021.20132
Valeberg, B. T., Dihle, A., Småstuen, M. C., Endresen, A. O., & Rustøen, T. (2021). The effects of a psycho-educational intervention to improve pain management after day surgery: A randomised clinical trial. Journal of clinical nursing, 30(7-8), 1132–1143. https://doi.org/10.1111/jocn.15659
Wang, T., Baskin, A. S., & Dossett, L. A. (2020). Deimplementation of the Choosing Wisely Recommendations for Low-Value Breast Cancer Surgery: A Systematic Review. JAMA surgery, 155(8), 759–770. https://doi.org/10.1001/jamasurg.2020.0322

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