As a minimally invasive ablation technology, cryoablation uses ultra-low temperature to form ice crystals in tumor cells. The cyclic process of freezing and rewarming would causes cell wall rupture, cell damage, small blood vessel obstruction, micro-thrombosis, etc., causing tissue ischemia and hypoxia, leading to ischemic necrosis of target cells and tissues. It is a good choice for patients with advanced tumors, especially those with poor physical conditions, advanced age, and those who cannot tolerate radical surgery.
It is worth noting that each treatment method has corresponding care precautions, and cryoablation treatment also has its corresponding post-operative care precautions. Effective nursing management ensures treatment, allows patients to recover faster, and further reduces the recurrence rate after surgery. Recently, Lu Yang, an operation nurse shared the nursing and management strategies during cryoablation therapy. Let's dive in.
1. Preoperative preparation
Psychological preparation: Educate patients through videos, past successful cases, and brochures to let them understand cryoablation technology and what will happen before, during, and after surgery;
Physical preparation:
o Complete related examinations, such as blood tests, liver and kidney functions, etc.;
o Bring imaging examination in the past month and laboratory examination in the past week;
o Stop anticoagulants 1 week ahead, take antihypertensive drugs with a sip of warm water in the morning, and follow doctor's advice for other medications;
o Prepare the skin, gastrointestinal tract, respiratory and circulatory systems, fast for 6 to 8 hours and 2 to 3 hours no drinking before surgery;
o Surgical site identification;
o Selection and establishment of infusion (liver - left side; lungs, breast - healthy side);
Preparation of medical equipment and items: itinerant nurses should be foreseeable and avoid leaving the operation table, going all out to cooperate with surgeons:
o Confirm the appropriate cryo-probe with the surgeon based on the surgical spot and tumor size;
o Check whether the gas volume can meet the needs of the next day’s surgery and equipment’s performance;
o Confirm the ultrasound or CT-scan scheduled time;
o Get items fully prepared. For instance, prepare bronchoscopes during lung cryoablation for hemoptysis, aspiration, and alveolar lavage; prepare OB glue, endocardial puncture needles, and gelatin sponges during liver cryoablation for ultrasound-guided hemostasis; prepare 50°C during breast cryoablation to prevent skin frostbite, 37°C saline water, PTC needle, and three-way extension tube to protect surrounding organs and prevent diaphragm damage if artificial thoracic and abdominal fluid are needed.
2. Intraoperative nursing
1) Confirm the patient's identity
Ensure that the information on the surgery notice, surgical record, patient wristband, imaging and patient expression are completely consistent;
2) The positioning should be reasonable
Fully expose the surgical field and protect the patient's privacy while reducing the impact on the patient's physiological functions;
3) Keep the infusion unobstructed
Prevent the infusion tube from prolapse during CT-scans and bed crossing;
4) Prevent displacement
Ensure patient’s comfort during surgical procedure;
5) Prevent intraoperative hypothermia
Adjust the temperature according to the actual situation by using heating blankets, rinsing with warm saline, using isolate subcutaneous water, maintaining the depth of the knife tip, etc.;
6) Closely observe vital signs
Caution cough, hemoptysis, pneumothorax and other symptoms that may occur during lung cryoablation; observe blood pressure, heart rate, blood oxygen and whether there are chills and bleeding tendencies during liver cryoablation; check skin condition during breast cryoablation; observe urine output and urine color during prostate and bladder cryoablation; observe the color of gastric tube during pancreatic cryoablation, etc.;
7) Actively and quickly respond to emergencies
Including accurately assessing the condition, quickly cooperating in handling, correctly executing medical instructions, and making timely reports.
3. Postoperative nursing
patients need to follow the doctor's instructions for appropriate rest and rehabilitation training after surgery for faster recovery. details as follows:
1) Rest and sleep
In the early post-operative period, patients need adequate rest and sleep to accelerate recovery. After regaining consciousness, the nurse should encourage the patient to gradually increase daily activity and walking but avoid strenuous activity and excessive fatigue. In addition, it is necessary to ensure that the patient gets enough sleep at night so that the body can gradually recover.
2) Diet
In the early stage after surgery, patients may experience symptoms of loss of appetite or nausea, and their diet needs to be adjusted appropriately according to the patient's condition. Patients need to gradually increase their diet and eat more digestible foods, such as soup, porridge, noodles, tofu, etc. Avoid spicy, greasy and irritating foods as they may affect wound healing.
3) Surgical wound care
In the early postoperative period, nurses need to check whether the wound is dry, clean and free of exudate, and whether there is hematoma around the puncture spots. The patient needs to avoid contamination or collision of the wound and keep the wound dry.
4) Pain Control
In the early postoperative period, patients may experience symptoms of pain. Nurses need to assess the patient's pain level. For mild pain, music could distract patient’s attention. If the pain cannot be controlled or worsens, nurses need to notify the doctor in time.
5) Emotional Support
Patients may experience symptoms such as mood swings or depression. Nurses need to provide emotional support to help them reduce anxiety and stress. The nurse should listen to the patient's questions and concerns and provide necessary comfort and support if need.
6) Safety controls
There are safety controls that patients need to follow during their post-surgery recovery period. Nurses need to instruct patients on how to stand, sit, walk, and go up and down stairs correctly to avoid accidents such as falls or slips. In addition, nurses also need to remind patients to pay attention to their body reactions when performing activities, and to report physical changes and discomforts to doctors and nurses in time.
7) Regular follow-up
Patients were required regular follow-up during the postoperative recovery period. Doctors and nurses need to monitor the patient's physical condition and recovery progress, and adjust treatment plans and nursing measures. Patients need to follow the doctor's advice and instructions and go to the hospital for regular check-ups and re-examinations.