Nursing care for women Nursing care for women undergoing Uterine Fibroid undergoing Uterine Fibroid Embolisation Embolisation Jan Jackson BSc ( Jan Jackson BSc ( Hons Hons ), DMS, CMS, RN, SEN (UK) ), DMS, CMS, RN, SEN (UK) Head Nurse, Imaging Directorate, Hammersmith Head Nurse, Imaging Directorate, Hammersmith Hospitals NHS Trust, London, UK Hospitals NHS Trust, London, UK Hammersmith Hospitals NHS Trust
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Nursing care for women Nursing care for women undergoing Uterine Fibroid undergoing Uterine Fibroid EmbolisationEmbolisation
Jan Jackson BSc (Jan Jackson BSc (HonsHons), DMS, CMS, RN, SEN (UK)), DMS, CMS, RN, SEN (UK)
Head Nurse, Imaging Directorate, Hammersmith Head Nurse, Imaging Directorate, Hammersmith Hospitals NHS Trust, London, UKHospitals NHS Trust, London, UK
Hammersmith HospitalsNHS Trust
UFE UFE -- BackgroundBackground
First used in late 1970s to control postFirst used in late 1970s to control post--partum bleedpartum bleed
RavinaRavina et al (1995) published results on et al (1995) published results on treatment for UF diseasetreatment for UF disease
-- effective in controlling symptoms 80effective in controlling symptoms 80--94%94%
-- fewer complicationsfewer complications
-- over 7,000 women treatedover 7,000 women treated
UFE UFE -- ReputationReputation
Reputation of being Reputation of being ‘‘quick and safequick and safe’’
UF UF -- What are they?What are they?
Common growths in female population (20 Common growths in female population (20 --50%)50%)Smooth muscle in originSmooth muscle in originPredominantly benignPredominantly benignMay be associated with reproductive May be associated with reproductive disordersdisordersAsymptomatic fibroid do not require Asymptomatic fibroid do not require treatmenttreatment
UF UF -- Type of FibroidType of Fibroid
Intramural Intramural -- common and common and develops in the wall of develops in the wall of uterusuterus
SubserosalSubserosal -- develops develops under outside covering of under outside covering of uterusuterus
SubmucosalSubmucosal -- develops develops under the inner lining of the under the inner lining of the uterus and is lease uterus and is lease common and problematiccommon and problematic
UF UF -- Population affectedPopulation affected
Increased incidence between the ages of Increased incidence between the ages of 35 35 -- 4949
AfroAfro--Caribbean women higher riskCaribbean women higher risk
Generic and hormonal factorsGeneric and hormonal factors
Performed by Interventional RadiologistsPerformed by Interventional Radiologists
Blood flow in the right and left uterine Blood flow in the right and left uterine arteries is occluded and the fibroids are arteries is occluded and the fibroids are deprived of their blood supplydeprived of their blood supply
Occlusion leads to necrosis and death of Occlusion leads to necrosis and death of the fibroidsthe fibroids
UFE UFE -- IndicationsIndications
Referred by gynaecologistReferred by gynaecologist
Symptomatic patients who have failed Symptomatic patients who have failed other therapy or do not wish to have other therapy or do not wish to have surgerysurgery
UFE UFE –– ContraindicationsContraindications
Coagulation disorder or other Coagulation disorder or other contraindication to angiographycontraindication to angiography
InfectionInfection
Other uterine pathology e.g. endometriosis, Other uterine pathology e.g. endometriosis, adenomyosis, canceradenomyosis, cancer
Patients who desire fertility and have Patients who desire fertility and have exhausted other alternativesexhausted other alternatives
Discuss with interventional radiologistDiscuss with interventional radiologist
Procedure explained Procedure explained
Patient information leafletPatient information leaflet
ConsentConsent
UFEUFE
THE ROLE OF THE THE ROLE OF THE
IMAGING NURSEIMAGING NURSE
UFE UFE -- Patient preparationPatient preparation
Hammersmith Hospitals NHS Trust
Directorate of Imaging
HAVING AUTERINE FIBROID EMBOLIZATION
Information for patients
l
HAMMERSMITH HOSPITAL
RADIOLOGY DEPARTMENT
VASCULAR ROOM
Extension: 34943
Type: Time:
Yes No
NIDDM ________________ IDDM ____________________
Last BM __________ Time __________ On Metformin Yes No
Urinary catheter in place. IV access in situ.
To be administered 1/2 hr prior to procedure
Voltarol suppositoire 100mg
Only for female patients of child bearing age.
Date of last LMP _____ / _____ / _____
If LMP more than 10 days: Pregnancy Test Positive Negative
Fasting:
- No solid food for 4 hours prior to procedure. - Clear fluids: offered up to 2 hours prior to procedure, then nil by mouth.* The max. intake of clear fluids between 4 and 2 hours preprocedure is 1 litre only.
PLEASE COMPLETE INVASIVE PROCEDURE CHECKLIST AS WELL AS THE IMAGING ONE
Doc
umen
tatio
n
I.P. Checklist Completed Procedure discussed and documented in medical notes
Signature ___________________ Print __________________ Date __ / __ / __ Time ___:___
Conscious sedationConscious sedationLocal anaesthesiaLocal anaesthesiaFemoral punctureFemoral puncturePelvic arteriogram performed Pelvic arteriogram performed Use of Use of microcathetersmicrocatheters and and guidewiresguidewires to to select uterine arteriesselect uterine arteriesPVAPVAFinal uterine arteriogramFinal uterine arteriogram
-- Solid food up to 4 hours prior to procedure.Solid food up to 4 hours prior to procedure.-- Clear fluids up to 2 hours prior to Clear fluids up to 2 hours prior to
procedure.procedure.-- Nil by mouth.Nil by mouth.
American Society of Anaesthesiologists Task Force on Sedation anAmerican Society of Anaesthesiologists Task Force on Sedation and Analgesia by nond Analgesia by non--anaesthesiologists (1996) Practice anaesthesiologists (1996) Practice guidelines for sedation and analgesia by nonguidelines for sedation and analgesia by non--anaesthesiologistsanaesthesiologists
UFE UFE -- PeriPeri--procedureprocedure
Conscious sedationConscious sedation
Pain managementPain management
-- pain assessmentpain assessment
Monitor vital signsMonitor vital signs
Comfort and reassuring patientComfort and reassuring patient
AntiAnti--emetic. emetic. ZofranZofran or or CyclizineCyclizine
UFE UFE -- Post Procedure SyndromesPost Procedure Syndromes
Pyrexia, nausea and vomitingPyrexia, nausea and vomiting
Pelvic painPelvic pain
Could last up to 24 Could last up to 24 -- 48 hours and up to 48 hours and up to
7 days7 days
Worse with large and multiple fibroidsWorse with large and multiple fibroids
UFE UFE -- ComplicationsComplications
Groin haematomaGroin haematomaPelvic painPelvic painUterine infection leading to hysterectomy Uterine infection leading to hysterectomy 0.5 0.5 -- 2%2%Fibroid impactionFibroid impactionPremature ovarian failure (menopause) 1 Premature ovarian failure (menopause) 1 --5%5%NonNon--target organ target organ ischaemiaischaemia2 reported deaths related to infection2 reported deaths related to infection
Average reduction of fibroid volume 41 Average reduction of fibroid volume 41 --64%64%
Reported pregnancy post UFEReported pregnancy post UFE
UFE UFE -- NICE GuidelinesNICE Guidelines
July 2003July 2003
Remains uncertain over safety and Remains uncertain over safety and effectivenesseffectiveness
Both gynaecologists and radiologists are Both gynaecologists and radiologists are involved in the decision to carry out involved in the decision to carry out procedureprocedure
BSIR RegistryBSIR Registry
Systemic reviewSystemic review
UFE UFE -- ConclusionConclusion
Good short term resultsGood short term results
Require long term followRequire long term follow--upup
Need to carry out RCTNeed to carry out RCT
Effect on pregnancyEffect on pregnancy
ReferencesReferences
Walker, WJ Walker, WJ –– Uterine Artery Uterine Artery EmbolisationEmbolisation for Symptomatic Fibroids: for Symptomatic Fibroids: Clinical Result in 400 Women with Imaging FollowClinical Result in 400 Women with Imaging Follow--up up
Siskin, GP et al (2000) Siskin, GP et al (2000) –– Outpatient Uterine Artery Outpatient Uterine Artery EmblisationEmblisation for for Symptomatic Uterine Fibroids: Experience in 49 patients, JVIR 1Symptomatic Uterine Fibroids: Experience in 49 patients, JVIR 11:3051:305--311311
National Institute of Clinical Excellence (NICE) National Institute of Clinical Excellence (NICE) –– Uterine artery Uterine artery embolisationembolisation for fibroids, 2003for fibroids, 2003
Ryan, JM et al (2002) Ryan, JM et al (2002) –– Simplified PainSimplified Pain--Control Protocol after Uterine Control Protocol after Uterine Artery Artery embolisationembolisation, Radiology 2002;224:610, Radiology 2002;224:610--613613