Personalized Nursing Approaches in Monitoring and Managing Hematoma Risks After Percutaneous Renal Biopsy: A...

This study investigates factors associated with large hematomas after percutaneous renal biopsy (PRB) and describes PRB-related complications in patients with native kidneys.

A prospective observational cohort study was conducted from September 2023 to May 2024 on 418 patients undergoing PRB at a nephrology department. The study collected data including demographic details, laboratory data, and preprocedure renal ultrasonography findings. The advanced practice nurse utilized point-of-care ultrasound to conduct immediate bedside ultrasound examinations following PRB. Postoperative monitoring involved periodic ultrasound assessments to measure hematoma size at 1, 6, and 24 h after the biopsy, complemented by pain evaluations using the Visual Analog Scale at 6 and 24 h.

The study investigated complications in 418 patients post-PRB, revealing that 7.7% experienced hematuria and hematoma incidence increased from 45.5% at 1 h to 56.0% at 24 h. ROC curve analysis identified critical cutoffs for predicting significant hematoma growth: 3.05 cm at 1 h (AUC = 0.827) and 4.125 cm at 6 h (AUC = 0.899). Factors significantly linked to larger hematomas at 24 h included activated partial thromboplastin time (APTT) (OR = 1.25, p = 0.001), 6-h hematoma diameter (OR = 2.05, p < 0.001), and 24-h post-PRB pain score at the puncture site (OR = 1.28, p = 0.022).

Higher APTT, larger hematoma diameter at 6 h, and higher puncture-site pain scores at 24 h were associated with large hematomas (≥ 5 cm) after PRB. These factors may serve as markers to support risk-stratified postbiopsy monitoring. Further studies are needed to determine whether nursing interventions guided by these markers can reduce complications or improve patient outcomes.

Nurse-led post-PRB monitoring may incorporate APTT, 6-h hematoma diameter, and pain assessment to support risk-informed surveillance. In clinically stable patients without signs of hematoma progression, light ambulation may be considered as an alternative to prolonged strict bed rest.