HDR Brachytherapy: GYN & Prostate — Nursing & Workflow Guide

👋 Welcome

High Dose Rate (HDR) Brachytherapy in Gynecologic & Prostate Cancer
A practical, step-by-step guide for nurses and clinical staff - Nursing responsibilities during applicator placement, CT-SIM, HDR delivery, and discharge
- Patient education, side effect management, and survivorship care
- Safety protocols and escalation pathways

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🔎 What is Radiation Therapy?

• External Beam RT (EBRT):
  • High-energy x-rays or protons delivered from outside the body.
  • Patients are not radioactive after EBRT.
• Brachytherapy (Internal RT):
  • Radioactive source placed inside or next to the tumor.
  • In HDR brachytherapy, the source is delivered for only minutes.
  • Patient is not radioactive after treatment.

---

💡 Why HDR Brachytherapy?

• Advantages:
  • Highly conformal dose → spares nearby organs.
  • Short treatment times (minutes vs. hours/days).
  • Outpatient procedure — same-day discharge.
• Nursing Perspective:
  • Reinforce that radiation source is not left in the body.
  • Manage anxiety by describing monitoring system (camera + microphone).

🎯 Indications: Gynecologic Cancers

• Cervical: Tandem & ovoid or interstitial boost after EBRT.
• Endometrial: Vaginal cylinder boost (adjuvant therapy).
• Vaginal: Cylinder or interstitial implants.

Nursing Role - Education about applicator placement. - Prep instructions (NPO, bowel prep, medication holds). - Psychosocial support during invasive procedures.

---

🎯 Indications: Prostate Cancer

• Definitive: HDR alone or with EBRT.
• Boost: HDR after EBRT.
• Salvage: For recurrence after prostatectomy.

Nursing Role - Educate on transperineal catheter placement & anesthesia. - Monitor for urinary retention/infection.

🧰 GYN Applicators: Vaginal Cylinder

• Most common for endometrial vaginal cuff boost.
  
• Outpatient; typically no anesthesia.
  
• First treatment may require bladder ± rectal catheter for contrast.

Nursing Role - Comfort & positioning support; insert urinary catheter if ordered. - Set expectations: treatment is painless, 5–20 min.

🧰 GYN Applicators: Tandem & Ovoid / Rotte (Y-Applicator)

• For cervical/uterine cancers.
  
• Often same-day surgery; first fraction in OR/PACU.
  
• Later fractions may be in clinic if easy placement.

Nursing Role - Pre-op education (NPO, clearance, bowel prep); IV placement & PACU monitoring. - Safe transport to HDR vault for treatment.

🧰 GYN Applicators: Interstitial Needles

• Used when tumor extends beyond cervix or vaginal wall.
  
• Template fixed to perineum; needles inserted through template (OR).

Nursing Role - Foley + rectal catheter placement; assist positioning & sterile field. - Monitor perineum for bleeding/swelling post-procedure.

🧪 Pre-Procedure Prep (GYN & Prostate)

• Labs & clearance 1–3 weeks before (anesthesia, EKG, CBC).
  
• Blood thinners: require prescriber clearance (e.g., Eliquis, warfarin, Xarelto, aspirin).
  
• Supplements: Stop vitamins/herbals ~2 weeks prior; NSAIDs hold 5 days; Tylenol OK.
  
• Bowel prep: Fleet enema 2 hrs before arrival.
  
• NPO after midnight if anesthesia required.

🧑‍⚕️ Nurse Management of Patients Receiving Spinal Anesthesia

A practical guide for perioperative and postoperative nursing staff

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🎯 Objectives

• Review the principles of spinal anesthesia
  
• Identify key nursing responsibilities pre-, intra-, and post-procedure
  
• Recognize common complications and nursing interventions
  
• Reinforce safe patient monitoring and education practices

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💉 What is Spinal Anesthesia?

• Regional anesthesia delivered into the subarachnoid space
  
• Blocks nerve transmission at the spinal cord
  
• Commonly used for lower abdominal, pelvic, obstetric, and lower limb procedures
  
• Rapid onset, reliable sensory and motor blockade

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🩺 Pre-Procedure Nursing Management

• Verify informed consent
  
• Review allergies, medications, and history (esp. anticoagulants, spinal disorders)
  
• Check baseline vitals & neurologic assessment
  
• Establish IV access
  
• Ensure NPO status (per protocol)
  
• Provide patient education and reassurance

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🩺 Intra-Procedure Nursing Management

• Positioning: sitting or lateral decubitus, support patient’s spine flexion
  
• Monitor vital signs continuously (HR, BP, SpO₂)
  
• Assist anesthesiologist with sterile field & patient comfort
  
• Communicate with patient to detect early complications:
  • tinnitus
    
  • metallic taste
    
  • numbness above expected block

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🛏️ Immediate Post-Anesthesia Nursing Care

• Position supine with slight head elevation
  
• Frequent vital signs (every 5–15 min initially)
  
• Monitor for:
  • Hypotension & bradycardia
    
  • High block (resp distress, difficulty speaking)
    
  • Nausea/vomiting
    
  • Urinary retention
    
• Maintain IV fluids and O₂ as ordered

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🛏️ Ongoing Postoperative Nursing Care

• Assess motor and sensory function return
  
• Monitor for spinal headache (worse upright, relieved supine)
  
• Encourage hydration and supine rest if headache develops
  
• Assess bladder function before discharge
  
• Provide pain management once block wears off

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⚠️ Common Complications

• Hypotension/Bradycardia → treat with fluids, vasopressors, atropine
  
• High Block/Total Spinal → emergency, call anesthesia, secure airway
  
• Spinal Headache → hydration, caffeine, may need blood patch
  
• Urinary Retention → monitor output, catheterize if needed

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🧑‍🏫 Patient Education

• Expected effects: numbness, weakness, temporary bladder issues
  
• Call nurse immediately if:
  • Severe headache
    
  • Breathing difficulty
    
  • Chest pain or dizziness
    
• Avoid driving or unassisted ambulation until fully recovered

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📚 Summary

• Nursing care spans pre-, intra-, and post-procedure phases
  
• Close monitoring ensures early recognition of complications
  
• Nurses play a vital role in patient education and safety throughout care

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🧭 CT-Simulation & HDR Delivery

CT-SIM - Confirms applicator/needle placement every fraction. - Contrast via urinary/rectal catheters as ordered. - First session planning may take 1–3 hours.

HDR Delivery - Afterloader sends source via catheters for planned dwell times. - Painless; monitored via camera/intercom.

🧾 Discharge, Education, & Follow-Up

• Discharge: activity/hygiene guidance; red flags (fever, heavy bleeding, retention).
  
• Education: SOP at consult, CT-SIM, OTV, final; provide booklets & NCI handouts.
  
• Follow-up: typically q3–6 months initially; APP-led visits common.

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👋 Welcome

High Dose Rate (HDR) Brachytherapy in Gynecologic & Prostate Cancer
A practical, step-by-step guide for nurses and clinical staff.

Image placeholders below are mapped to graphics from the education booklet. Save exported images as images/image_1.png … images/image_10.png in the same folder as this .Rmd.

---

🔎 What is Radiation Therapy?

• External Beam RT (EBRT):
  • High-energy x-rays or protons delivered from outside the body.
  • Patients are not radioactive after EBRT.
• Brachytherapy (Internal RT):
  • Radioactive source placed inside or next to the tumor.
  • In HDR brachytherapy, the source is delivered for only minutes.
  • Patient is not radioactive after treatment.

Placeholder — “What is radiation therapy?” graphic from patient booklet.

---

💡 Why HDR Brachytherapy?

• Advantages:
  • Highly conformal dose → spares nearby organs.
  • Short treatment times (minutes vs. hours/days).
  • Outpatient procedure — same-day discharge.
• Nursing Perspective:
  • Reinforce that radiation source is not left in the body.
  • Manage anxiety by describing monitoring system (camera + microphone).

Placeholder — “External vs. internal radiation” conceptual figure.

---

🎯 Indications: Gynecologic Cancers

• Cervical: Tandem & ovoid or interstitial boost after EBRT.
• Endometrial: Vaginal cylinder boost (adjuvant therapy).
• Vaginal: Cylinder or interstitial implants.

Nursing Role - Education about applicator placement. - Prep instructions (NPO, bowel prep, medication holds). - Psychosocial support during invasive procedures.

Placeholder — Schematic of cylinder in vagina/cervix (booklet diagram).

---

🎯 Indications: Prostate Cancer

• Definitive: HDR alone or with EBRT.
• Boost: HDR after EBRT.
• Salvage: For recurrence after prostatectomy.

Nursing Role - Educate on transperineal catheter placement & anesthesia. - Monitor for urinary retention/infection.

Placeholder — Generic prostate HDR schematic (insert your site image).

---

🧰 GYN Applicators: Vaginal Cylinder

• Most common for endometrial vaginal cuff boost.
  
• Outpatient; typically no anesthesia.
  
• First treatment may require bladder ± rectal catheter for contrast.

Nursing Role - Comfort & positioning support; insert urinary catheter if ordered. - Set expectations: treatment is painless, 5–20 min.

Placeholder — Cylinder placement diagram.

---

🧰 GYN Applicators: Tandem & Ovoid / Rotte (Y-Applicator)

• For cervical/uterine cancers.
  
• Often same-day surgery; first fraction in OR/PACU.
  
• Later fractions may be in clinic if easy placement.

Nursing Role - Pre-op education (NPO, clearance, bowel prep); IV placement & PACU monitoring. - Safe transport to HDR vault for treatment.

Placeholder — Tandem & ovoid applicator diagram.

---

🧰 GYN Applicators: Interstitial Needles

• Used when tumor extends beyond cervix or vaginal wall.
  
• Template fixed to perineum; needles inserted through template (OR).

Nursing Role - Foley + rectal catheter placement; assist positioning & sterile field. - Monitor perineum for bleeding/swelling post-procedure.

Placeholder — Interstitial template/needle diagram.

---

🧪 Pre-Procedure Prep (GYN & Prostate)

• Labs & clearance 1–3 weeks before (anesthesia, EKG, CBC).
  
• Blood thinners: require prescriber clearance (e.g., Eliquis, warfarin, Xarelto, aspirin).
  
• Supplements: Stop vitamins/herbals ~2 weeks prior; NSAIDs hold 5 days; Tylenol OK.
  
• Bowel prep: Fleet enema 2 hrs before arrival.
  
• NPO after midnight if anesthesia required.

Placeholder — Pre-op checklist/OR arrival info graphic.

---

🧭 CT-Simulation & HDR Delivery

CT-SIM - Confirms applicator/needle placement every fraction. - Contrast via urinary/rectal catheters as ordered. - First session planning may take 1–3 hours.

HDR Delivery - Afterloader sends source via catheters for planned dwell times. - Painless; monitored via camera/intercom.

Placeholder — CT-SIM scanner / HDR vault illustration.

---

🧾 Discharge, Education, & Follow-Up

• Discharge: activity/hygiene guidance; red flags (fever, heavy bleeding, retention).
  
• Education: SOP at consult, CT-SIM, OTV, final; provide booklets & NCI handouts.
  
• Follow-up: typically q3–6 months initially; APP-led visits common.

Placeholder — “After you are done with therapy” follow-up graphic.