Pre‐procedure

ActionRationale

1. 1.Show
   Explain and discuss the procedure with the patient.
   To ensure that the patient understands the procedure and gives her valid consent (Faithfull and Wells [17], E).
2. 2.Show
   Check treatment has been terminated by:

   • Ensuring the appropriate channel lights are green.
   • Ensuring the time display on the Selectron unit reads zero for the appropriate channels.
   • Ensuring the print‐out indicates that treatment has stopped for those channels.
   The applicators should be removed only on completion of treatment. E

   To ensure that the treatment completed corresponds with the patient. This is essential when delivering treatment via the same machine to two patients at the same time. E
3. 3.Show
   Check that the closed‐circuit television camera is not focused on the patient.
   To ensure privacy and dignity. E

Procedure

1. 4.Show
   Ensure any pre‐removal drugs have been administered.
   To allow analgesic and/or sedative medications time to be effective. E
2. 5.Show
   Assist the patient into a comfortable position with her knees apart.
   To allow access to the applicators. E
3. 6.Show
   Uncouple the plastic transfer tubes by rotating the black coupling anticlockwise in the direction of the arrow and very carefully storing the tubes on the plastic supporting mantle attached to the Selectron unit.
   To prevent the plastic catheter becoming damaged or kinked. E
4. 7.Show
   Place rubber caps on the ends of the applicators.
   To ensure no fluid or debris is allowed to enter the applicator tubes. E
5. 8.Show
   Commence administration of Entonox (see Chapter c22) at least 2 minutes before removal of the applicators if patient has consented to that.
   To allow the effect of the gas to become maximal. E
6. 9.Show
   Prepare the equipment and put on non‐sterile gloves.
   This procedure is clinically clean and not aseptic (Rossoff et al. [60], R1b).
7. 10.Show
   Remove the vulval dressing pads and any sutures and vaginal packing.
   These must be removed before the applicators can be eased out. E
8. 11.Show
   Dismantle the applicators by loosening the screws holding them together.
   To promote ease of removal. E
9. 12.Show
   Remove the uterine tube first, ensuring it is taken out complete with its small white flange, and then remove the remaining applicators and the ovoids.

   Check all parts of the equipment used in the procedure are accounted for.
   To prevent the flange being left in the patient's vagina. E

   To ensure no equipment or packing has been left in the patient. E
10. 13.Show
    Remove the catheter after the balloon has been deflated, provide vulval care and ensure the patient has a clean sanitary pad and a fresh sheet under her.

    Educate the patient to inform the team when she has passed urine after the catheter has been removed.
    To promote cleanliness and patient comfort.

    Observe for any bleeding post applicator removal. E

    To identify any changes to the vulva or surrounding skin areas. E

    To ensure that there is no urinary retention post catheter removal. E
11. 14.Show
    The patient can then be assisted into a comfortable position. Instruct the patient to inform the nurse when she requires assistance with personal hygiene as she adjusts to an upright position.
    To reassure the patient that the procedure has been completed, that she is no longer receiving radiation treatment and can resume normal activities. E

Post‐procedure

1. 15.Show
   Applicators are then placed into CSSD return bags and returned to CSSD for cleaning in accordance with local policies.
   To ensure correct sterilization and/or disposal. E