In patients with an ICP/ICD, multidisciplinary approach with frequent assessments heightens safety during radiation

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NEW ORLEANS—A multidisciplinary approach focusing on patient education and frequent assessment was effective at safely providing radiation to patients with an implanted cardiac pacemaker/defibrillator (ICP/ICD), according to research presented at the Oncology Nursing Society (ONS) 37th Annual Congress.

The number of patients with an implanted ICP/ICD treated with radiation therapy has been increasing. When these patients receive radiation, the health care team  must bear in mind the effects that treatment will have on the cardiac device. The radiation nurse must coordinate with the radiation oncologist, physicist, and manufacture to safely facilitate chemotherapy.

At The Barbara Ann Karmanos Cancer Center, Detroit, MI, a literature review led by Pamela Laszewski, RN, and team revealed that their policy of weekly manufacture assessment of the ICP/ICD was not current with standards of practice. Researchers conducted a study to demonstrate evidence-based nursing interventions in the care of the radiation patient with an implanted cardiac device that their institution could use to update their institutional policy on pacemaker assessments.

At the time of the radiation consult, patients with ICP/ICDs were identified, a copy of their pacemaker card was placed in their chart, and the radiation oncologist and physicist were notified. The physicist calculated the total direct dose of radiation that the ICP/ICD would be exposed to and the physician was notified of this dose.

The manufacturer's clinical specialist came to clinic and verified the function and settings of the ICP/ICD prior to starting treatment and on a weekly basis during treatment. The findings were reported to the nurse. On a weekly basis, the nurse and physician assessed patients for any cardiac signs and symptoms, including dizziness/lightheadedness, fatigue, shortness of breath, and irregular heart rate.

During the study period, 23 patients received weekly ICP/ICD manufacturer assessments. No malfunctions or changes in the settings were found. The results of this study were presented to the leadership committee. The policy was updated so the ICP/ICD was assessed prior to the start and at the completion of radiation treatment.

During the next year, 8 patients were treated with an ICP/ICD using the new policy. These devices also experienced no changes or malfunctions. The patients continued to have weekly evaluations by the nurse and physician for any cardiac changes. At the completion of treatment, the patients were instructed to follow up with their cardiologist.

“Patients receiving radiation therapy with an ICP/ICD requires a multidisciplinary approach. The radiation nurse must coordinate with members of the health care team, educate the patient and family members and assess the patient's cardiac status. This study provided us with evidence to change our policy to deliver care safely to our patients with a cardiac device,” the researchers concluded.

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