COVID-19 Information

Guidelines for CT Procedures: Work Up and Approval

If any deviation from the below guidelines is planned, the approving physician must either perform the biopsy themselves, or speak directly with the physician who will be doing it.

Coags & platelets:

  • Inpatients: Must be obtained for all biopsies
  • Outpatients: Must be obtained within 30 days for all biopsies in patients with:
    • significant EtOH history
    • history of liver disease of any cause
    • cirrhosis
    • hepatitis
    • history of coagulopathy, Coumadin use, thrombocytopenia
    • history of chemotherapy within 30 days
    • history of hematologic malignancy
  • Thresholds for approval: Platelets > 50, INR <1.5
    If lab values deviate from above thresholds, the approving physician must discuss the case with the physician who will be performing the procedure, or schedule it on their own procedure day

Medication discontinuation:

    • Plavix and Aspirin must be discontinued 5 days prior to all biopsies
    • Coumadin must be discontinued 5 days prior to the procedure*. Approving physician should determine (in conjunction with ordering physician) if a lovenox bridge is necessary & make these arrangements, or coordinate with nursing to make them.

*call ordering physician for cases where there is high risk of thrombosis if Coumadin is d/c'd. This includes mechanical heart valves, atrial fibrillation, DVT treated for < 1 mth; determine if lovenox bridge is needed & arrange this

2 Site biopsies

  • It is rare that biopsying 2 sites on the same day is necessary
  • Approving physician must either do the biopsies themselves, or speak directly with the physician who will be doing them.

Pre-procedure note

  • Should be done at the time of procedure approval
  • In eDH; use the "CTPRE" template
  • Minimum content should include:
    • Site, indication
    • Anti-coag or platelet meds and the plan for stopping them
    • Lab values: coags and platelets... either report the value or indicate if it is pending, if appropriate. If abnormal, write the plan for replacing them, or rationale for proceeding despite abnl
    • Rationale/indication for performing the procedure as this may not always be evident
    • Please describe findings on prior radiologic studies such that this information may be used for planning if this study is not readily available