Standard Met/Initials Competency Areas
Prerequisite Skills
Knowledge of the anatomy and physiology of the cardiovascular system, particularly the location and function of the superior vena cava (SVC)
Understanding of superior vena cava syndrome (SVCS) as a group of signs and symptoms that occur as a result of the obstruction of blood flow through the SVC due to extrinsic compression on the vein by a tumor or enlarged lymph node, or due to an intravascular process such as the presence of a thrombus
Understanding that sudden, severe obstruction is a potentially life-threatening medical emergency
Knowledge that lung cancer is the most common malignant cause of SVCS, and that
• patients with cancer in the upper lobe of the right lung are at an increased risk for SVCS due to the close proximity of this portion of the lung to the superior vena cava
• other cancers associated with SVCS include
• non-Hodgkin’s lymphoma
• Hodgkin’s lymphoma
• thymoma
• mediastinal metastasis (e.g., from breast or testicular cancer)
• mesothelioma
• Kaposi’s sarcoma
Familiarity with signs and symptoms of SVCS, which include
• a sensation of fullness in the head
• chest pain
• dyspnea (i.e., shortness of breath)
• cough
• dysphagia (i.e., difficulty swallowing)
• nonpitting edema of the neck
• facial and tongue edema
• visible distention of the veins in the neck and chest wall
• more serious manifestations that warrant immediate intervention, including stridor, headache, dizziness, syncope, changes in mental status (e.g., confusion), and seizures
Understanding that management of SCVS is important to relieve symptoms, prolong life, and improve quality of life
Understanding of the desired outcome of managing SVCS in patients with cancer, which includes
• relief of symptoms and prevention of complications
• maintenance of airway patency
• promotion of adequate tissue perfusion and oxygenation
• treatment of the underlying malignancy
• promotion of patient comfort
Understanding that management of SCVS is determined by the cause of disease, symptom presentation, and overall patient prognosis
• Management consists of treating the cancer and managing symptoms and may be curative or palliative depending upon the patient’s prognosis. In some cases, emergency interventions are required
Knowledge that treatment for SVCS is specific to the underlying disease and can include
• radiation therapy
• chemotherapy
• percutaneous endovascular stent placement
• thrombolytic therapy (e.g., streptokinase, urokinase)
• surgery
Knowledge that nursing interventions involved in the management of SVCS include
• Administering oxygen therapy to relieve hypoxia
• Restricting fluids; monitoring fluid intake and output
• Adjusting the environment to promote rest and decrease anxiety
• Promoting bed rest or strict activity limitations
• Elevating the head of the patient’s bed to facilitate drainage of fluid by gravity and reduction of facial edema
• Administering prescribed medications, which may include
• diuretics to decrease edema
• steroids to decrease laryngeal and cerebral edema
• analgesics for comfort
• sedatives to reduce anxiety
• thrombolytics or anticoagulants for thrombosis
• Assisting with diagnostic procedures and clinical interventions, as appropriate
• Supporting patients by establishing a relationship of trust and rapport
• Providing patient education
Preparation
Reviews the facility/unit specific protocol for management of cancer-related SVCS, if one is available
Reviews the treating clinician’s order for management of SVCS
• Notes prescribed oxygen therapy, prescribed medications, and activity limitations
Reviews the manufacturer’s instructions for all equipment to be used and verifies that the equipment is in good working order
Verifies completion of facility informed consent documents, as appropriate
Reviews the patient’s medical history/medical record for
• history of cancer, cancer treatment, and SVCS
• any allergies (e.g., to latex, medications, or other substances); uses alternative materials, as appropriate
Gathers the following supplies:
• Sterile/nonsterile gloves; additional personal protective equipment (PPE; e.g., gown, mask, eye protection)may be needed if exposure to body fluids is anticipated
• Facility-approved pain assessment tool
• Equipment to monitor vital signs
• Pulse oximeter
• Prescribed medication
• I.V. supplies (e.g., tubing, pump, pole, alcohol pads), as needed
• Oxygen administration supplies (e.g., oxygen source, tubing, delivery device)
• Laboratory collection supplies (e.g., blood collection tubes, labels) as appropriate
• Written information, if available, to reinforce verbal education on SVCS
Procedure
Performs hand hygiene and dons PPE
Identifies the patient according to facility protocol
Establishes privacy by closing the door to the patient’s room and/or drawing the curtain surrounding the patient’s bed
Introduces self to the patient and family member(s), if present; explains clinical role; assesses the coping ability of the patient and family and for knowledge deficits and anxiety regarding the care that will be provided in the management of SVCS
• Determines if the patient/family requires special considerations regarding communication (e.g., due to illiteracy, language barriers, or deafness); makes arrangements to meet these needs if they are present
• Uses professional certified medical interpreters, either in person or via phone, when language barriers exist
• Explains the procedure for management of cancer-related SVCS and its purpose; answers any questions and provides emotional support as needed
• Reassures the patient that physical manifestations of SVCS (e.g., cyanosis, facial edema) will subside with the effects of treatment
Assesses the patient’s general health status, including his/her pain level using a facility-approved pain assessment tool
Performs frequent patient assessments
• Monitors vital signs
• Assesses oxygen saturation by pulse oximetry
• Assesses for the presence of face, neck, or arm swelling, distention of neck veins, presence of collateral chest veins, and respiratory insufficiency
• Monitors for any potentially life-threatening manifestations (e.g., respiratory distress, stridor, changes in mental status or level of consciousness) of SVCS; Follows facility protocols to contact the treating clinician and initiate emergency interventions as appropriate
Monitors airway patency, and promotes adequate perfusion and oxygenation. Performs nursing interventions to support respiratory and functional status, such as
• encouraging bed rest
• elevating the head of the bed
• administering oxygen, as ordered
• assisting with self-care and daily care to prevent exertional dyspnea
Maintains accurate intake and output records
Maintains I.V./central line patency, per facility protocol
Collects/arranges for collection of blood for laboratory tests, as ordered, and reviews results (e.g., CBC, renal function tests) as they become available
Administers medications, as ordered; monitors for desired effects of medications and for any adverse medication effects
Provides patient education and assists with preparation of the patient for medical interventions, as appropriate
Disposes of used materials in proper receptacles and performs hand hygiene
Post-Procedural Responsibilities
Provides patient/family education
• If the patient is cared for at home or will be discharged to home after treatment for SVCS, explains how to contact the treating clinician if questions or problems arise
• Emphasizes the importance of keeping scheduled follow-up medical appointments to allow continued medical surveillance of the patient’s condition, as appropriate
• Directs the patient/family to the appropriate resource (e.g., social worker) for information about local support groups and other services to assist with coping with cancer and cancer complications
Updates the patient’s plan of care, if appropriate, and documents care that will be provided in the management of SVCS in the patient’s medical record, including the following information:
• Date and time of nursing care provided
• Description of specific interventions performed, including administration of oxygen and any medications
• Patient assessment findings, such as
• level of pain
• level of consciousness
• vital signs
• oxygen saturation
• signs and symptoms of SVCS
• Laboratory specimens collected and sent for analysis
• Patient’s response to the nursing care provided, including any pain/discomfort during and immediately following the intervention
• Any unexpected patient events or outcomes, interventions performed, and whether or not the treating clinician was notified
• Patient/family member education, including topics presented, response to education provided/discussed, plan for follow-up education, and details regarding any barriers to communication and/or techniques that promoted successful communication