Causes, Management, And Perioperative Nursing Key Points Of Common Complications Of Chiba Needle Percutaneous Biopsy And Drainage

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Although the Chiba needle is a fine needle (usually ≥20G), the complication rate is much lower than that of thick-core cutting biopsy (serious complications <1%), but it is still necessary to fully understand the potential risks and standardize prevention and control.

1. Bleeding and Hematoma

Most common in liver/kidney biopsy, mostly small subcapsular hematomas around the puncture tract, self-limiting. Causes: accidental puncture of blood vessels, unqualified coagulation function, uncontrolled hypertension, repeated multiple punctures. Manifestations: abdominal/back pain after puncture, decreased blood pressure, decreased Hb, hypoechoic fluid on ultrasound. Management: mild cases rest in bed, fluid replacement, hemostatic drugs (tranexamic acid/aminomethylbenzoic acid), monitoring; active massive bleeding requires CTA confirmation followed by interventional embolization. Prevention: strict preoperative coagulation check (PT/APTT/PLT), blood pressure control, imaging guidance to avoid large blood vessels, limit puncture attempts to ≤2–3 times on the same side, withdraw the needle slowly along the original tract without swinging.

2. Pneumothorax and Hemopneumothorax (Lung Biopsy)

The incidence of pneumothorax after CT-guided pulmonary nodule FNA is about 5%–15%, most of which are small and self-absorbed; those requiring closed chest drainage are <2%. High-risk factors: lesions deep in the lung periphery near the pleura, COPD/emphysema, multiple punctures, needle passing through interlobar fissures or bullae, patient inability to cooperate with breath-holding. Management: small pneumothorax (<30% lung compression, asymptomatic) observed for 24–48 hours with repeat chest X-ray; moderate to large or with dyspnea, give needle aspiration or closed drainage. Prevention: choose the shortest pleural crossing path (be cautious with interlobar approach), use 22G fine needle, single puncture, train breath-holding, observe in bed after surgery and review chest X-ray.

3. Infection - Bacteremia/Abscess/Cholangitis

Seen after PTC/PTCD or incomplete drainage of abdominal abscesses. Causes: retrograde injection of contaminated contrast, spread of existing infection, lax aseptic technique. Manifestations: fever >38.5°C, chills, elevated WBC, turbid drainage fluid. Management: blood/drainage fluid culture + sensitivity, escalate antibiotics; if necessary, adjust drainage tube position or add flushing. Prevention: antibiotics before and after surgery (especially biliary intervention), limited contrast injection, strict aseptic technique, regular flushing of drainage tubes.

4. Needle Tract Seeding Metastasis (Rare)

Tumor cell implantation along the puncture tract is extremely rare (reported <0.01%–0.05%), mostly seen in highly aggressive tumors such as malignant melanoma and sarcoma. Prevention: use coaxial technique (outer cannula left in the tract, inner needle does not contact surrounding tissues when withdrawn), choose the finest effective needle diameter, compress the puncture tract after surgery.

5. Other Rare Complications

Vagal reflex (carotid/neck biopsy): bradycardia, hypotension → atropine.

Biliary peritonitis (poor PTCD drainage/side holes not fully in bile duct): readjust the tube or peritoneal drainage.

Accidental injury to adjacent organs (colon/stomach/gallbladder): avoid by path planning, real-time ultrasound monitoring.

Perioperative Nursing Key Points:

① Preoperative: check coagulation, allergy history, fasting (for general anesthesia/deep sedation), psychological comfort, train breath-holding; ② Intraoperative: aseptic cooperation, assist in fixing posture, remind of breath-holding timing, observe complexion/vital signs; ③ Postoperative: puncture site compression for hemostasis, dressing coverage, bed rest according to site (lung biopsy 2–4h, PTCD 6h), monitor BP/P/R/abdominal pain/respiration/drainage fluid character, report abnormalities promptly (progressive bleeding, difficulty breathing, high fever, severe abdominal pain), provide health education (no water contact for 24h, avoid strenuous exercise for 3 days, observe puncture site).

Standardized complication management is based on "strict indication control + precise imaging guidance + standard operation + close observation." Overall, Chiba needle FNA is an extremely safe minimally invasive diagnostic method.