COMPLICATIONS AFTER RENAL TRANSPLANT BIOPSY: EFFICACY OF FOUR-HOUR MONITORING PERIOD

2.50
Hdl Handle:
http://hdl.handle.net/10755/211565
Type:
Research Study
Title:
COMPLICATIONS AFTER RENAL TRANSPLANT BIOPSY: EFFICACY OF FOUR-HOUR MONITORING PERIOD
Abstract:
Aim: Our aim was to evaluate the incidence, presentation and timing of complications occurring after renal transplant biopsy to determine if transferring patients from recovery to other areas can be performed without intensive nursing monitoring and without compromising patient safety. Background: In conducting a study on use of MRI imaging to differentiate acute rejection from acute tubular injury in renal transplant patients, questions arose regarding the safety of taking patients away from the Transplant Clinic for MRI imaging during their 4 hours of post-biopsy monitoring. Methods: This study was IRB approved and HIPAA compliant. Medical records from patients with renal biopsies from 1/1/2000 to 12/31/2009 were reviewed for the evidence of a complication, presenting symptoms, and timing. All biopsies were performed using real-time US guidance and an 18-gauge core biopsy device. Standard post-biopsy monitoring included vital signs every 15 minutes for 1 hour, then every 30 minutes for 3 hours, hematocrit evaluation at 4 hours post-biopsy and bed rest for 4 hours in a recovery room in the Transplant Clinic. Results: Of the 3738 biopsies performed, there were 25 (0.67%) mild and 41 (1.1%) moderate to severe complications as defined by the Common Terminology Criteria for Adverse Events (v4.0). All of the moderate and severe complications were related to hemorrhage, with the moderate complications requiring medical management (including serial hematocrits and blood transfusions) and the severe complications necessitating surgical evacuation of hematoma. For both groups, the patients most commonly presented with abdominal pain (16/41, 39%) and/or decreased hematocrit (15/41, 37%). The majority of moderate to severe complications (25/41, 61%) presented within 4 hours post-biopsy. Nine patients presented in less than 1 hour, 3 in the second hour, 6 in the third hour, and 7 in the fourth hour. Implications: Our study demonstrated a low risk of moderate to severe complications from a renal transplant biopsy and all complications were related to bleeding. Patients most commonly presented with abdominal pain and decreasing hematocrit. A 4 hour post-biopsy observation period identified the majority of patients with moderate to severe complications (61%). Monitoring strategies should include regular inquiry about pain level and performance of serial hematocrits. If the patient requires transfer outside of the immediate recovery area during the 4 hour post-biopsy monitoring period, appropriate care must be taken to ensure there are frequent checks of the patient’s pain level and care to have the patient’s hematocrit drawn at the ordered time. Additional monitoring strategies may also be needed later, as 39% of moderate to severe complications occur more than 4 hours after biopsy.
Keywords:
Renal transplant biopsy; Complications
Repository Posting Date:
20-Feb-2012
Date of Publication:
20-Feb-2012
Other Identifiers:
5492
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typeResearch Studyen_GB
dc.titleCOMPLICATIONS AFTER RENAL TRANSPLANT BIOPSY: EFFICACY OF FOUR-HOUR MONITORING PERIODen_GB
dc.identifier.urihttp://hdl.handle.net/10755/211565-
dc.description.abstractAim: Our aim was to evaluate the incidence, presentation and timing of complications occurring after renal transplant biopsy to determine if transferring patients from recovery to other areas can be performed without intensive nursing monitoring and without compromising patient safety. Background: In conducting a study on use of MRI imaging to differentiate acute rejection from acute tubular injury in renal transplant patients, questions arose regarding the safety of taking patients away from the Transplant Clinic for MRI imaging during their 4 hours of post-biopsy monitoring. Methods: This study was IRB approved and HIPAA compliant. Medical records from patients with renal biopsies from 1/1/2000 to 12/31/2009 were reviewed for the evidence of a complication, presenting symptoms, and timing. All biopsies were performed using real-time US guidance and an 18-gauge core biopsy device. Standard post-biopsy monitoring included vital signs every 15 minutes for 1 hour, then every 30 minutes for 3 hours, hematocrit evaluation at 4 hours post-biopsy and bed rest for 4 hours in a recovery room in the Transplant Clinic. Results: Of the 3738 biopsies performed, there were 25 (0.67%) mild and 41 (1.1%) moderate to severe complications as defined by the Common Terminology Criteria for Adverse Events (v4.0). All of the moderate and severe complications were related to hemorrhage, with the moderate complications requiring medical management (including serial hematocrits and blood transfusions) and the severe complications necessitating surgical evacuation of hematoma. For both groups, the patients most commonly presented with abdominal pain (16/41, 39%) and/or decreased hematocrit (15/41, 37%). The majority of moderate to severe complications (25/41, 61%) presented within 4 hours post-biopsy. Nine patients presented in less than 1 hour, 3 in the second hour, 6 in the third hour, and 7 in the fourth hour. Implications: Our study demonstrated a low risk of moderate to severe complications from a renal transplant biopsy and all complications were related to bleeding. Patients most commonly presented with abdominal pain and decreasing hematocrit. A 4 hour post-biopsy observation period identified the majority of patients with moderate to severe complications (61%). Monitoring strategies should include regular inquiry about pain level and performance of serial hematocrits. If the patient requires transfer outside of the immediate recovery area during the 4 hour post-biopsy monitoring period, appropriate care must be taken to ensure there are frequent checks of the patient’s pain level and care to have the patient’s hematocrit drawn at the ordered time. Additional monitoring strategies may also be needed later, as 39% of moderate to severe complications occur more than 4 hours after biopsy.en_GB
dc.subjectRenal transplant biopsyen_GB
dc.subjectComplicationsen_GB
dc.date.available2012-02-20T12:02:36Z-
dc.date.issued2012-02-20T12:02:36Z-
dc.date.accessioned2012-02-20T12:02:36Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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