Management of Postembolization Syndrome Following Hepatic Transarterial Chemoembolization for Primary or Metastatic Liver Cancer.
BACKGROUND
Transarterial chemoembolization (TACE) is an established treatment in managing liver primary neoplasms or liver metastases. Postembolization syndrome (PES) is a common adverse event defined as fever without associated sepsis, pain in the right upper quadrant, and nausea and/or vomiting.


OBJECTIVE
This integrative review aims to identify effective management strategies for PES or one of its characterizing symptoms (fever, pain, and nausea and/or vomiting).


METHODS
Searches of electronic databases MEDLINE, EMBASE, and CINAHL were conducted. Fifteen articles were identified for inclusion. Seven addressed all symptoms of PES, and 8 studies focused on individual symptoms of PES.


RESULTS
Interventions identified are intra-arterial lidocaine, oral and intravenous analgesics, steroids, wrist-ankle acupuncture, antibiotics, and 5-HT3 receptor antagonists. Findings are explicated according to individual symptoms of PES. Intra-arterial lidocaine, steroids, and a 5-HT3 receptor antagonist are found to offer potential benefit in the management of PES symptoms.


CONCLUSIONS
A number of interventions have shown potential benefit in the management of PES. A systemic approach using combination therapy is necessary to effectively manage characterizing symptoms. Further research is needed to determine the impact of primary disease site, TACE technique, and chemotherapeutic agent on PES.


CONCLUSIONS
Oncology nurses are uniquely placed to undertake thorough patient assessment after TACE and implement early intervention to effectively manage PES.
Author Affiliations: North Shore Private Hospital (Ms Blackburn) and Sydney Nursing School, University of Sydney (Ms Blackburn and Dr West), New South Wales, Australia.
Helen
H
Blackburn
Sandra
S
West
D015746:Abdominal Pain / Q000628:therapy; D015667:Acupuncture Analgesia / Q000379:methods; D000284:Administration, Oral; D000700:Analgesics / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016461:Chemoembolization, Therapeutic / Q000379:methods* / Q000592:standards; D019468:Disease Management; D004359:Drug Therapy, Combination / Q000379:methods; D005335:Fever of Unknown Origin / Q000628:therapy; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000379:methods; D007275:Injections, Intravenous / Q000379:methods; D008012:Lidocaine / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D009020:Morphine / Q000627:therapeutic use; D009859:Oncology Nursing / Q000379:methods* / Q000639:trends; D010098:Oxycodone / Q000627:therapeutic use; D020250:Postoperative Nausea and Vomiting / Q000628:therapy; D058831:Serotonin 5-HT3 Receptor Antagonists / Q000627:therapeutic use; D013256:Steroids / Q000627:therapeutic use
D000700:Analgesics; D000900:Anti-Bacterial Agents; D058831:Serotonin 5-HT3 Receptor Antagonists; D013256:Steroids; D009020:Morphine; D008012:Lidocaine; D010098:Oxycodone