Congress Abstracts 2005

42

NURSING MANAGEMENT OF PATIENTS UNDERGOING HEPATIC EMBOLIZATION FOR HEPATOCELLULAR CARCINOMA. Lisa Wall, RN, PhD, OCN^®, Memorial Sloan-Kettering Cancer Center, New York, NY.

Hepatocellular carcinoma (HCC), the most common cancer world wide, is a primary cancer of the liver. The best treatment for HCC is surgical resection; however, for individuals with multifocal disease or risk factors that preclude surgery, hepatic embolization is a good alternative to control disease. Nurses must be concerned with preparing patients for hepatic embolization, closely monitoring their response to the treatment, and providing emotional support.

The purpose of this presentation is to describe hepatic embolization and to identify the nurse’s role in supporting patients through this procedure. Hepatic embolization is a procedure performed in interventional radiology whereby the arterial blood flow feeding the tumor is located by computerized tomography (CT). Tiny pellets are inserted via an arteriogram to block off the tumor’s blood supply. This creates a tumor lysis syndrome thereby shrinking or killing the tumor.

Nurses contribute to the safety of embolization through patient education, assessment and symptom management. Pre-procedure, nurses instruct patients to avoid medications and products that affect coagulation. Platelet and prothrombin times must be evaluated before and after embolization since many patients with HCC have low platelet counts due to cirrhosis and are at increased risk for bleeding. Post-procedure, adequate hydration is encouraged to counteract the effect of contrast dye used during the procedure. Complications to assess for include bleeding, infection and hepatic injury. Signs and symptoms of concern include decreased hemocrit and hemoglobin, fever with increased white blood cell count and increased bilirubin level.

Slight elevations in liver function tests and alpha-fetoprotein (AFP) are expected within the first month after embolization. Therefore, evaluation of treatment effectiveness can best be determined 6–8 weeks after embolization through CT scan and decreased AFP. Embolization may be repeated; however, it is not curative and patients must be monitored for signs of liver failure due to progressive disease.

In selective patients, embolization effectively controls HCC for many years. Since HCC is commonly found in patients with hepatitis and cirrhosis, embolization can be complicated by these comorbidities. Nurses play an important role in safely managing patients through treatment and supporting them as they live with a potentially fatal disease.