The Royal Marsden Manual of Cancer Nursing Procedures

Foreword xi Acknowledgements xii List of contributors xiii List of abbreviations xv Quick reference to the procedure guidelines xvii How to use your manual xix Introduction xxi 1 Diagnostic investigations 1 Overview 2 Diagnostic tests and investigations 2 Tumour markers 4 Cervical uterine smear 8 Diagnostic radioisotope procedures (nuclear medicine) 12 Transrectal ultrasound (TRUS) prostate biopsy 18 Flexible cystoscopy 24 Breast diagnostics 36 Clinical breast examination 38 Core biopsy 40 Breast fine-needle aspiration (FNA) 43 Breast punch biopsy 45 Nipple discharge smear 47 Genetic testing 48 Websites 52 References 52 Procedure guidelines for Chapter 1 1.1 Cervical uterine smear using liquid-based cytology 9 1.2 Unsealed radioactive sources for diagnostic investigations 16 1.3 Transrectal ultrasound (TRUS) prostate biopsy 21 1.4 Flexible cystoscopy 27 1.5 Flexible cystoscopy with stent removal 30 1.6 Flexible cystoscopy with bladder biopsy 32 1.7 Flexible cystoscopy with argon plasma coagulation (APC)/cystodiathermy 35 1.8 Clinical breast examination 38 1.9 Core breast biopsy 41 1.10 Breast fine-needle aspiration (FNA) 43 1.11 Breast punch biopsy 45 1.12 Nipple discharge smear 47 2 Haematological procedures 57 Overview 58 Bone marrow procedures 58 Aspiration and trephine biopsy 58 Bone marrow harvest 67 Apheresis 72 Ribavirin administration 80 Pentamidine isetionate administration 84 Websites 87 References 87 Procedure guidelines for Chapter 2 2.1 Bone marrow aspiration and trephine biopsy 64 2.2 Bone marrow harvest 68 2.3 Apheresis 76 2.4 Ribavirin administration 82 2.5 Pentamidine isetionate administration 85 3 Cancer pain assessment and management 91 Overview 92 Cancer pain assessment and management 95 Pain management 97 Acupuncture 104 Interventional techniques for managing complex cancer-related pain 107 Single nerve blocks and injections 108 Regional peripheral and plexus nerve blocks and infusions 108 Neuraxial (spinal) blocks: epidural and intrathecal analgesia 109 Entonox (nitrous oxide) administration 120 References 125 Procedure guidelines for Chapter 3 3.1 Acupuncture: preparation and administration 106 3.2 Epidural/intrathecal sensory blockade: assessment 114 3.3 Epidural/intrathecal exit site dressing change 115 3.4 Epidural/intrathecal catheter removal 115 3.5 Entonox administration 123 4 Administration of systemic anticancer therapies 131 Overview 132 Systemic anticancer treatment 132 Safe handling of hazardous drugs 133 Administration of cytotoxic medications by nurses 137 Intravenous administration of systemic anticancer therapy 138 Extravasation 142 Oral administration of systemic anticancer therapy 156 Intramuscular and subcutaneous administration of cytotoxic drugs 162 Topical application of cytotoxic drugs 164 Intrathecal administration of cytotoxic drugs 165 Intrapleural instillation of cytotoxic drugs 168 Intravesical instillation of cytotoxic drugs 169 Intraperitoneal instillation of cytotoxic drugs 172 Intra-arterial administration of cytotoxic drugs 173 Side-effects of chemotherapy 175 Haematological side-effects 176 Fatigue 176 Gastrointestinal side-effects 176 Adverse drug reactions 177 Neurotoxicity 177 Mucositis/stomatitis 177 Nephrotoxicity/haemorrhagic cystitis 178 Cardiotoxicity 178 Pulmonary toxicity 178 Hepatotoxicity 178 Skin toxicities 178 Alopecia 178 Clinical research 184 References 193 Procedure guidelines for Chapter 4 4.1 Cytotoxic spillage management 135 4.2 Cytotoxic therapy: intravenous administration of cytotoxic drugs 141 4.3 Extravasation management: peripheral cannula 150 4.4 Extravasation: performing flush-out following an extravasation 152 4.5 Cytotoxic therapy: education for patients on oral cytotoxic drugs 161 4.6 Cytotoxic therapy: intramuscular administration of cytotoxic drugs (Z-track) 163 4.7 Cytotoxic therapy: topical application of cytotoxic drugs 164 4.8 Cytotoxic therapy: intraventricular administration of cytotoxic drugs via an intraventricular access device (Ommaya reservoir) 166 4.9 Cytotoxic therapy: intrapleural instillation of cytotoxic drugs 168 4.10 Cytotoxic therapy: intravesical instillation of cytotoxic drugs 170 4.11 Cytotoxic therapy: intraperitoneal instillation of cytotoxic drugs 172 4.12 Intra-arterial administration of cytotoxic drugs 174 4.13 Scalp cooling 182 5 Radionuclide therapy 201 Overview 202 Radiation 202 Radiation protection 202 Unsealed source therapy 207 Sealed source therapy 211 Sealed source iodine-125 seeds used in prostate malignancies 220 Intraoral sealed sources 220 Websites 223 References 223 Procedure guidelines for Chapter 5 5.1 Radiation protection: major spillage of radioactive body fluids through incontinence and/or vomiting 204 5.2 Radiation protection: contamination of bare hands by radioactive body fluids 205 5.3 Radiation protection: death of a patient who has received unsealed radioactive source therapy 205 5.4 Radiation protection: cardiac arrest of a patient who has received unsealed radioactive source therapy 205 5.5 Radiation protection: evacuation due to fire of patients who have received unsealed radioactive source therapy 206 5.6 Unsealed source therapy: entering and leaving the room of a patient who has received an unsealed radioactive source 208 5.7 Unsealed source therapy: iodine-131 (oral capsule/liquid): administration 209 5.8 Unsealed source therapy: iodine-131 mIBG treatment: patient care 209 5.9 Sealed source therapy: caesium sources (manual or afterloading): patient care 216 5.10 Sealed source therapy: low dose-rate Selectron treatment 217 5.11 Sealed source therapy: Selectron applicator removal 218 5.12 Sealed source therapy: insertion of sealed radioactive sources into the oral cavity 221 6 Wound management 227 Overview 228 Malignant fungating wounds 228 Wound assessment 230 Treatment options 232 Principles of the management of dressings for a malignant fungating wound 235 Local wound management 235 Graft-versus-host disease wounds 244 Definition 244 Skin care following radiotherapy 245 Websites and useful addresses 249 References 249 Procedure guidelines for Chapter 6 6.1 Assessing a malignant fungating wound 231 6.2 Dressing a malignant fungating wound 243 7 Acute oncology 253 Overview 254 Haematological emergencies 255 Central venous access device complications 255 Thrombosis (catheter related) 259 Sepsis 260 Major artery rupture 261 Superior vena cava obstruction 262 Metabolic emergencies 264 Hypercalcaemia of malignancy 264 Hypomagnesaemia 267 Side-effects from chemotherapy agents 268 Diarrhoea (chemotherapy and radiotherapy induced) 268 Nausea and vomiting 271 Neutropenic sepsis 277 Pneumonitis 280 Structural 281 Ascites (malignant) 281 Bowel obstruction (malignant) 287 Metastatic spinal cord compression 289 Pericardial effusion (malignant) 301 Raised intracranial pressure due to malignant disease 302 References 303 Procedure guidelines for Chapter 7 7.1 Carotid artery rupture (CAR) 262 7.2 Abdominal paracentesis 284 7.3 Log rolling for suspected/confirmed cervical spinal instability 292 7.4 Positioning for suspected/confirmed cervical spinal instability: pelvic twist to right 295 7.5 Log rolling for suspected/confirmed thoracolumbar spinal instability 297 7.6 Early mobilization of the patient in bed 298 8 Living with and beyond cancer 311 Overview 312 Section 8.1 Introduction 312 The experience of living with or beyond cancer 312 Section 8.2 Welfare advice 315 Overview 315 Websites 326 Useful addresses 326 Section 8.3 Supporting individuals with sexual concerns as a consequence of cancer 326 Women’s sexual concerns following cancer 329 Interventions 331 Men’s sexual concerns following cancer 332 Interventions 333 Websites 334 Section 8.4 Nutritional status 334 Websites 339 Section 8.5 Compression therapy in the management of lymphoedema 339 Lymphoedema 339 Assessment of the patient with lymphoedema and calculation of limb volume 341 Compression bandaging 348 Compression garments 357 Adjustable wrap compression systems 361 Websites 365 Section 8.6 Non-pharmacological management of breathlessness 366 Non-pharmacological support 367 Websites 371 Section 8.7 Physical activity for people with cancer 371 Websites 377 Section 8.8 Cancer-related fatigue and sleep 377 Cancer-related fatigue 377 Sleep 380 Section 8.9 Communication for a patient with a laryngectomy 383 Websites and useful addresses 389 Section 8.10 Nipple tattooing 390 References 396 Procedure guidelines for Chapter 8 8.1 Conducting a holistic needs assessment (HNA) 314 8.1a Developing and actioning a care plan 315 8.1b Closure and follow-up 315 8.2 How a patient should make a claim for Personal Independence Payment 322 8.3 How a patient should make a claim for Attendance Allowance 323 8.4 How a patient should make a claim for Carer’s Allowance 324 8.5 How a patient should make a claim for Employment and Support Allowance 325 8.6 Assessing a patient’s sexual health concerns 327 8.7 Measuring the weight, height and waist circumference of the patient 336 8.8 Compression therapy limb volume calculation: lower limb 346 8.9 Compression therapy limb volume calculation: upper limb 346 8.10 Compression bandaging (multilayer short-stretch): bandaging arm and the fingers 350 8.11 Compression bandaging (multilayer short-stretch): bandaging a leg and the toes 354 8.12 Elastic compression garments: application to the leg 359 8.13 Elastic compression garments: application to the arm 360 8.14 Adjustable wrap compression system: application to the lower leg 363 8.15 Adjustable wrap compression system: application to the arm 364 8.16 Breathlessness management: using a handheld fan 368 8.17 Breathlessness management: essential oil administration via aroma stick inhaler 370 8.18 Supporting physical activity 375 8.19 Fatigue management 378 8.20 Relaxation and anxiety management 382 8.21 HME placement 387 8.22 Voice prosthesis: cleaning in situ 388 8.23 Nipple tattooing 394 9 End of life care 403 Overview 404 Last Offices 408 Websites and useful addresses 416 Online resources 416 References 416 Procedure guideline for Chapter 9 9.1 Last Offices 411 Index 419