How is the patient prepped for a temporal artery biopsy?

Updated: Sep 04, 2018
  • Author: Andrew A Winkler, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Answer

See the list below:

  • This and every surgical procedure begins with a frank discussion with the patient regarding the steps of the procedure, the risks, and the potential benefits.

  • After consent is obtained, the patient is positioned as described above.

  • If desired, apply 4% liposomal lidocaine to the temporal area and allow 15-20 minutes for it to take effect. This should ideally be completed prior to marking the patient, because markings can be removed when the topical cream is wiped off.

  • The surgeon or a properly trained nurse/assistant marks the course of the superficial temporal artery by palpating the pulse. If necessary, a pencil-type Doppler ultrasound with water-based lubrication may be used.

    • In general, the superficial temporal artery is palpable just anterior to the tragus. However, a highly affected vessel may be pulseless and thickened because of diffuse inflammation. In these cases, a hard, ropelike vessel may be palpable in the area of the superficial temporal artery. When the inflammatory process is extensive, flow through the artery can be greatly diminished. If neither a pulse nor cordlike vessel can be palpated, intraoperative Doppler ultrasonography will help to locate the vessel.

    • Markings should begin just anterior to the tragus and continue well into the hairline. Mark out the surgical incision vertically within the temporal hair and greater than 3 cm from the temporal hairline.

  • After marking is performed, a 3-cm radius ring block around the planned incision is performed using the 1:1 lidocaine/bupivacaine mixture.

  • Shave the hair in an area 2 cm around the incision. Next, prepare the skin using an antiseptic solution. The authors prefer benzalkonium chloride because it is safe in and around the eyes, but any skin preparation solution will do.

  • Drape the area with sterile towels in a manner that avoids completely covering the patient's eyes and face, as this can cause claustrophobia.


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