M5.2019 Undertake biopsy of breast tissue using imaging

Overview

This standard is about the use of imaging equipment to locate regions in the breast perceived to be abnormal. The standard also covers the use of this equipment to guide biopsy procedures. It is essential that any person undertaking this procedure be currently competent in Basic Life Support and Cardio-Pulmonary Resuscitation. Key people are those involved in the individual's care and others involved in provision of services. Users of this standard will need to ensure that practice reflects up to date information and policies. Version No 2

Knowledge and Understanding

You will need to know and understand:

1. legal, organisational and policy requirements relevant to your role, the role of others in your organisation and the activities being carried out
2. the relevant national and local standards, guidelines, policies and procedures that are available and how and when they should be accessed
3. the importance of respecting individuals' culture, privacy, dignity, wishes, beliefs and decisions
4. the limitations of your own knowledge and experience and the importance of operating within your scope of practice
5. the roles and responsibilities of other team members
6. the importance of obtaining valid consent in line with national and local guidelines
7. the purpose of the breast diagnostic and screening services
8. the quality assurance programmes in symptomatic, assessment and breast screening services
9. the mammographic manifestations of breast disease and normal variations as a result of age, hormonal state, surgery and radiotherapy
10. the anatomy, physiology and pathology of the breast, axilla, subcutaneous tissues and associated structures
11. the changes in images, physical appearance or feel of breast tissue as a result of age, surgery, hormonal state, medication or radiotherapy
12. the local protocols for biopsy procedures
13. the appearance of abnormal or suspicious areas on mammograms
14. local policies for aseptic technique
15. the contra-indications to the procedure
16. how to review an individual's clinical history for factors which might contra-indicate the procedure
17. the underlying principles of stereotaxis
18. how to adapt communication styles, ask questions, and listen carefully in ways which are appropriate for the needs of the individual
19. methods of communicating difficult and complex information to individuals and key people
20. the importance of providing individuals and key people with opportunities to ask questions and increase their understanding
21. the information that should be given to individuals before, during and on completion of the examination
22. the biopsy equipment, its correct preparation, attachment and calibration
23. the safe use of local anaesthesia
24. the appearance of biopsy samples and indications for imaging specimens
25. the importance of accurate labelling of samples
26. the possible complications during and after biopsy of breast tissue and their management
27. the need to optimise the radiation dose received by the individual
28. the features of the relevant imaging equipment and the imaging process
29. how to keep full, accurate and clear records in line with organisational procedures

Performance Criteria

You must be able to do the following:

1. apply standard precautions for infection prevention and control and other appropriate health and safety measures
2. prepare the equipment required for the procedure and check it is working correctly
3. examine relevant images prior to performing the procedure to confirm the location(s) of the region(s) of interest
4. review all additional relevant information and decide the most appropriate approach
5. review the individual's clinical history for factors which might contra-indicate the procedure
6. ensure the environment is conducive to maintaining the privacy and dignity of the individual
7. check the identification details before commencing the procedure in accordance with local policies and procedures
8. communicate with the individual / key people to facilitate their understanding of and co-operation with the examination
9. establish the individual's capacity to understand the procedure with the help of key people if necessary
10. obtain valid consent for the procedure in accordance with national and local guidelines
11. respect the individual's privacy, dignity, beliefs and decisions
12. explain the procedure in a manner which encourages the individual to relax and co-operate with the requirements of the procedure
13. assess the individual's emotional needs and respond appropriately
14. take appropriate images to confirm the correct position for needle placement and safety margins
15. take all appropriate precautions to ensure a clean/aseptic technique
16. ensure that local anaesthetic is given according to local protocols and loss of sensation is checked and, where required, the skin is incised
17. insert the correct needle for the procedure according to local procedures and protocols
18. check the positioning of the needle is correct by further imaging and make any necessary adjustments according to local procedures and protocols
19. take, check and site mark samples according to local procedures and protocols
20. ensure haemostasis of the wound
21. dress the biopsy site appropriately
22. label sample containers and complete pathology request forms
23. provide the individual with information relating to the procedure and aftercare where necessary
24. explain the process for obtaining results
25. document the procedure according to local protocols
26. issue reports of the specimen radiograph to the surgical team according to local protocols
27. recognise where help or advice is required and obtain this from appropriate sources

Additional Information

This National Occupational Standard was developed by Skills for Health. This standard links with the following dimension within the NHS Knowledge and Skills Framework (October 2004): Dimension: HWB6 Assessment and treatment planning