Congress Abstracts 2003

19

MANAGING PATIENT POST HEPATIC ARTERIAL EMBOLIZATION: THE INPATIENT NURSE’S ROLE. Natasha Ramrup, RN, MSN, and Nina Bachmen, RN, MSN, Memorial Sloan-Kettering Cancer Center, New York, NY.

The incidence of hepatocellular cancer (HCC) is on the rise. Surgical resection is the only curative treatment modality for this aggressive malignancy. Many patients diagnosed with HCC have inoperable disease because of underlying cirrhosis, secondary to predisposing conditions such as viral and alcoholic hepatitis. Distant metastatic disease or locally advanced tumors may preclude a curative resection.

Since only 10%–25% of the patients with HCC are eligible for surgical resection, other treatment modalities have been incorporated into the treatment algorithms. In the past decade, a variety of interventional radiologic procedures have been employed for the local control of HCC. HAE is a palliative radiologic procedure used to control symptoms and delay disease progression. The interventional procedure occludes the specific blood supply to the tumor thereby inducing necrosis and inhibiting growth, while preserving normal liver parenchyma and function.

At this NCI-designated comprehensive cancer center, approximately 150 HAE are performed annually. Clinical management and treatment of these patients is complex and best accomplished by a multidisciplinary healthcare team. Nursing interventions focus on physical care, psychosocial support, and patient/family education. Nurse’s collaboration with the medical staff and support disciplines ensures optimal patient care post HAE. Nursing care is directed at prompt recognition of symptom management of potential side effects.

A common complication associated with embolization is Post Embolization Syndrome (PES), which consists of fever, nausea, vomiting, leucytosis, and pain resulting from cell lysis. Other complications include sudden fluctuation in blood pressure, septicemia, bleeding, biliary complications, liver abscess, and hematoma. It is imperative that the inpatient nurse understands the complications associated with this procedure in order to better manage the patient in the post-procedure period.

For nursing, the management focuses on understanding the anatomy, pathophysiology, procedure, and treatment complications, thereby facilitating the care the patient will receive post embolization. This presentation will: 1) provide an overview of the disease and HAE treatment, 2) describe patient/caregiver education, and 3) describe the inpatient nurses role in managing complications post HAE. As more interventional procedures are on the horizon for palliation of HCC, inpatient nurses will face new challenges in order to provide effective, safe patient care.