The Royal Marsden Manual of Cancer Nursing Procedures

The Royal Marsden is the world’s first hospital dedicated to cancer diagnosis, treatment, research and education – a centre of excellence with an international reputation for ground-breaking research and pioneering the very latest in cancer treatments and technologies, as well as specialising in cancer diagnosis and education.  

This companion volume to the internationally successful The Royal Marsden Manual of Clinical Nursing Procedures is designed to support practitioners who work specifically with oncology patients by providing detailed evidence-based procedures and rationale, and problem-solving guidance on all aspects of oncology nursing.

The Royal Marsden Manual of Cancer Nursing Procedures:

• Is organized and structured to represent the needs of the patient along their care pathway
• Provides the latest evidence underpinning all procedures
• Includes information on haematological procedures; pain assessment and management; wound care; oncological emergencies; and end-of-life care
• Gives detailed guidelines on supporting patients living with cancer with practical information on such things as benefits, exercise and nutrition.

The Royal Marsden Manual of Cancer Nursing Procedures is an invaluable, definitive resource for all those involved in the provision of cancer care and support to patients and their families.

Sara Lister RN, PGDAE, BSc(Hons), MSC, MBACP, The Pastoral Care Centre, The Royal Marsden NHS Foundation Trust, UK.

Lisa Dougherty OBE, RN, MSc, DClinP, Nurse Consultant Intravenous Therapy, The Royal Marsden NHS Foundation Trust, UK.

Assistant Editor: Louise McNamara, B.Nursing; MSc in Advancing Professional Healthcare Practice, UK.

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

The New copy of this book will include any supplemental materials advertised. Please check the title of the book to determine if it should include any access cards, study guides, lab manuals, CDs, etc.

The Used, Rental and eBook copies of this book are not guaranteed to include any supplemental materials. Typically, only the book itself is included. This is true even if the title states it includes any access cards, study guides, lab manuals, CDs, etc.