Breast Brachytherapy Using Mammography Guidance in the Breast Center HF#5928

You have chosen breast brachytherapy for your radiation treatment.  We want to welcome you to our department and give you some information that will help you during your treatment.

 

If you need to stay overnight in Madison during your treatment and would like help finding a local hotel at a discount rate, please contact our housing coordinator at 608-262-0315.  Some local hotels offer shuttle service to and from the hospital

 

If you select brachytherapy, you will be asked to sign two consent forms.  One consent form is for the placement of the catheters.  The second consent form is for the actual radiation treatment.  We will take a photograph of your face.  This picture will be placed in your chart for identification purposes.  We will also take pictures of your breasts to plan for the catheter placement.  All pictures remain in your clinic chart and will be kept private and confidential.

 

The catheter placement is scheduled for ___________________________.  This placement will take 2-3 hours. Some of the medicine you will take before the procedure will make you sleepy.  You will need someone to drive you to and from the hospital.  Eat a light meal the morning of the placement.  Take your normal prescription medicines. You should not drive or make important decisons until the next day.

 

You will be given a number of prescriptions.  It is important that you fill these and take these medicines as directed.  Your doctor or nurse will explain this to you.  If you do not take these medicines as prescribed, you must tell your doctor before the catheter placement.  Tell your doctor or nurse if you have allergies to any of these medicines.

 

1. EMLA® cream.  This is an anesthetic cream that you will put directly on your skin.  Apply one to two hours before the catheter placement.  Cover the cream with a transparent dressing (Tegaderm®) or household Saran® wrap.  The dressing will keep the cream on your skin.  Apply at _____________________.

 

1. Valium® 5mg.  This is a sedative or anti-anxiety medicine.  Take 1 tablet 45 minutes before the catheters are placed.  Keep on taking this only if needed.  Don’t drive if you take this medicine.  Take at ____________________.

 

1. Percocet® or Roxicet® (oxycodone and acetaminophen 5mg/325mg) or Vicodin® (hydrocodone and acetaminophen 5mg/500mg).  This is a narcotic pain medicine.  Take 1 tablet 45 minutes before the catheters are placed.  Keep on taking it if needed.  Don’t drive if you take this medicine.  This medicine can cause constipation.  If you were given a prescription for a pain medicine after your surgery, you may take that instead. Take at ________________________.

 

1. Naproxen sodium 220 mg. (Aleve^® for example).  This is a nonsteroidal anti-inflammatory medicine.  It will reduce pain and swelling.  Take 1 tablet 45 minutes before the catheters are  placed.  Keep on taking this medicine twice daily through your treatments.  You may drive if you take this medicine.  Take at ____________________.

 

Check with your doctor if you take any blood thinning medicines.  These may need to be stopped at least one week ahead of time.  See the list below:

 

• Aspirin or products that contain aspirin, Ecotrin^®, Excedrin^®
• Heparin
• Coumadin^®
• Non-steroidal anti-inflammatory drugs Advil^®, Motrin^®, Aleve^®, Nuprin^®
• Some herbal medicines

 

If you are allergic to Lidocaine or epinephrine contrast, or latex, please let us know.

 

Day of Catheter Placement

 

The date of catheter placement _______________________________.

 

Please arrange for someone to drive you home after the procedure.  Eat a light meal since you will be flat on your stomach during the procedure.

 

Apply the EMLA® cream and take the prescribed medicines at the given times.

 

Wear comfortable clothing.  A button-down shirt will be easiest to take off and put on.

 

Report to the Breast  Center (G3/1) at _____________ on the first floor near the cafeteria.

 

The first step, after you check in, is a mammogram.  This is needed even if you had a mammogram recently.  An ultrasound exam is done next.  During the ultrasound some air and special dye (Omnipaque^®) will be injected into the fluid cavity from your surgery.  If you have an allergy to contrast dye, please tell your doctor.  A second mammogram will be done after this.

 

You will go to the procedure room.  The catheter placement is a sterile procedure.  You will see staff in gowns and masks.   Your breast will be cleaned with an iodine solution.  You will lie face down on the table, and place your breast through a round hole in the table.  You will lie in this position for about 2 hours.

 

 

Your doctors or the staff will talk with you during the entire time.  Please tell your doctor if you feel any pain or discomfort.  The procedure should take 2-3 hours.  The steps are listed below:

 

1. The brachytherapy template will be placed on your breast.  You will feel pressure but you should not feel pain.  The template may be re-positioned a number of times.  A mammogram will be done in this position to determine where the needles should be inserted.

 

1. A local anesthetic will be injected into your breast.  This anesthetic contains Lidocaine, epinephrine, and sodium bicarbonate.  Most patients feel nothing because the EMLA cream numbs the skin, but you may feel small pinpricks.  If you feel more than this, tell your doctor.

 

1. The brachytherapy needles will be placed into the breast through the template.  A mammogram may be done several times during this process.

1. After all needles have been placed, plastic catheters will be slid through each needle.  The needles will then be removed.  A plastic tab (button) will hold each catheter in place.

1. You will sit up.  Your skin and breast will be washed.  An antibiotic ointment will be applied.  The catheters covered with a sterile dressing.  A special support bra will hold the catheters in place.

 

1. After this, you can go home.  You will feel tired from the medicines.  Plan to rest for the rest of the day and evening.

 

Evening after Catheter Placement

 

Because of the medicine you took before the placement, you may feel tired. 

 

You may have some discomfort when the local anesthetic wears off.  This is normal.  Take the naproxen as scheduled and the pain medicine if you need it.

 

An ice pack on top of the dressings may help relieve the pain.

 

Do not get the dressings or catheters wet.

 

Do not remove the support bra.  Sometimes, the dressings may shift.  Wash your hands before you adjust the dressings.

 

Take your temperature before bedtime.  Call your doctor if you have a temperature of 100.0° F or more. 

 

Day after Catheter Placement

 

Report to Radiation Oncology on _____________________________at ________ for a CT scan.  A CT scan is a computerized x-ray that will be used for your treatment plans.  When this is completed each catheter will be numbered and its depth will be measured.  This will take about an hour and a half.

 

You may eat and drink liquids before the CT scan.

 

You may want to take at least one pain pill before you arrive.  During the planning session, the catheters will be touched.  They might be slightly sore and tender.

 

Take your temperature 3 times a day.  Report a temperature of 100.0°F and above.

 

Wear loose comfortable clothing like a button-down shirt that is easy to take off and put on.  After the CT scan, a nurse will look at and clean your skin around the catheters and antibiotic ointment will be put around each button.  New dressings will be put on and secured by the support bra.  You will get a schedule for your treatment times.

 

Week-end

 

Continue to take your temperature 3 times a day.  Call your doctor if your temperature is 100.0°F or higher.

 

Your arm motion might be slightly limited because of the catheters.  Avoid lifting more than 10 pounds with the arm on the treatment side.

 

The support bra and dressing are only removed during your treatments.  Keep this area dry.

 

Radiation Treatment Appointments

 

Every day, once in the morning, check in at Patient Registration at Main Street in the hospital.  You will also check in at the Radiation Oncology clinic (K4/B100), twice a day, before each treatment.  You will have two treatments a day, with 6 hours between each treatment. Each treatment will last about one hour.   You will see a doctor at each treatment.  The total number of treatments is determined by your doctor.  Most patients will have 10 treatments.

 

In the treatment room the nurse will remove the support bra and dressing.  Each catheter will be connected to the radiation treatment machine by a flexible tube.  The radioactive source travels into each catheter, one by one, until the treatment is complete.  The nurse or physicist will tell you how long each treatment will last.  Most people do not feel anything during the treatment.

 

You will hear a sound from the treatment machine.  You will be alone in the room during the treatment, but the staff will see you on a TV monitor and be able to talk with you on an intercom. 

 

After the treatment is over, the radioactive source will return into the machine.  The physicist and nurse will enter the room.  A special monitor will confirm that the radioactive source is safely back in the treatment machine.  The cables will be disconnected.  A nurse will clean the catheters and apply a new dressing before you leave. 

 

 

After the treatment, neither you nor the catheters are radioactive.  You are not a risk to your family and friends.

 

Completion of Treatment

 

After the last treatment, a nurse will remove the catheters.  There is usually little or no pain  or bleeding. 

 

The nurse will clean your breast and put antibiotic ointment on the catheter sites.  You will be instructed on skin care and given all the skin care supplies that you will need to care for yourself.

 

Take your temperature twice a day for 1 week, then daily for 1 week.  Call if your temperature is 100.0°F or higher.  Check your breast daily for signs of infection: redness, swelling, non-clear drainage.

 

If you have any questions or concerns, please call us.

 

Radiation Oncology Clinic   (608) 263-8500

If you live out of the area:  1-800-323-8942.  Ask for the Radiation Oncology Clinic.

 

If the clinic is closed, the phone will be transferred to the paging operator.  Ask for the Radiation Oncology doctor on call.  Leave your name and phone number with the area code.  The doctor will call you back.

 

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 12/10/2012

Copyright © 01/12/2011 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5928

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