Pre‐procedure

ActionRationale

1. 1.Show
   Before beginning, it is important to explain and discuss the procedure fully with the patient. Explain that the coldest and most uncomfortable time is the first 15 minutes after the cap has been applied. The patient should understand that the scalp cooling can be discontinued at any time and that it will not jeopardize the chemotherapy.
   To ensure that the patient understands the procedure and what the success rate is likely to be depending on the type of chemotherapy regimen they are receiving (Dougherty [58], R2b). Patients who have undergone scalp cooling highlighted this as important knowledge to share when first undergoing the procedure (Dougherty [58], R2b). To ensure that the patient gives their valid consent and knows that if the scalp cooling does not work, they can obtain a wig (NMC [178], C).

Procedure

1. 2.Show
   Check that the machine has been cooled to the recommended temperature.
   To ensure the coolant will be circulated at the correct temperature to be effective (manufacturer's recommendations, C).
2. 3.Show
   Ascertain the correct cap size for the patient by ensuring that the manufacturer's recommendations relating to cap size are followed. Good cap fitting includes ensuring the cap is touching the crown of the head and that there is a tight fit around the entire hairline.
   To ensure the cap is in close contact with the scalp (manufacturer's recommendations, C).
3. 4.Show
   If necessary, wet hair or comb through conditioner.
   To ensure there is adequate cooling over the head including all the hair roots. E
4. 5.Show
   Place the cap on the patient's head, making sure it fits closely and covers the whole hairline.
   To ensure the cap is in close contact with the scalp (manufacturer's recommendations, C).
5. 6.Show
   Apply the overcap to the patient's head.
   To ensure even and close contact of the cap to the scalp (Dougherty [58], R2b).
6. 7.Show
   Place protection in any areas where the cap touches the skin.
   To prevent cold injury and improve the patient's comfort. E, P
7. 8.Show
   Place a pillow behind the patient's head if required.
   To provide support for the patient's head and neck and to reduce the effect of the heaviness of the cap (P; Dougherty [54], R2b).
8. 9.Show
   Offer the patient the use of a blanket.
   To provide the patient with some protection against the feeling of cold (P; Dougherty [54], R2b).
9. 10.Show
   Leave the patient for at least 15 minutes before injection of the drug.
   To obtain initial cooling of the scalp (Dougherty [58], R2b; Hunt et al. [107], R4; Lemenager et al. [135], R2b; manufacturer's recommendations, C).
10. 11.Show
    Administer the drug by intravenous injection as per prescription.
    To administer treatment as appropriate. E
11. 12.Show
    The cap must be on continuously for the recommended times (although the patient may detach themselves for a short period if they need to go to the toilet).
    To maintain adequate cooling (Dougherty [58], R2b; Hunt et al. [107], R4; Lemenager et al. [135], R2b).
12. 13.Show
    On completion of drug administration (i.e. the one likely to cause alopecia, for example epirubicin), leave the patient for the allocated time depending on the drug and where appropriate according to the manufacturer's recommendations.
    To maintain cooling until the plasma levels of drug have fallen (Dougherty [58], R2b; Hunt et al. [107], R4; Janssen [116], R2b; Lemenager et al. [135], R2b).
13. 14.Show
    When sufficient time has elapsed, remove the cap.
    To prevent damage to the scalp and hair. E, P

Post‐procedure

1. 15.Show
   Encourage the patient to rest, if desired.
   To prevent the patient feeling faint when the cap is lifted off the head. P, E
2. 16.Show
   Allow the patient to wash and dry their hair before leaving department
   To ensure patient comfort. E
3. 17.Show
   Wash or wipe the cap with detergent wipes, dry and store on cardboard insert or according to manufacturer's instructions.
   To minimize cross‐infection and to maintain shape (DH [46], C).
4. 18.Show
   Ensure the patient is given a patient information booklet on how to care for hair and manage hair loss.
   To reinforce verbal information given during the procedure. E, P