Preventing Vasovagal/Syncopal Episodes During Prostate Fiducial Marker Placement

Abstract

During prostate marker procedures, a rectal probe is inserted to visualize the prostate and place fiducial markers. Patients are placed in the lithotomy position for the procedure and post procedure they are placed in a sitting position to recover. Immediate post-procedural complications are rare but their incidence and mitigation strategies are poorly understood. We report the results before and after the adoption of a nursing intervention to reduce complications.The nature and incidence of immediate post-procedural complications within 60 minutes were qualitatively studied between July 2018 and August 2019. During the study period, a non-pharmacological nursing intervention was adopted. The intervention included lying the patient supine for 30 minutes, infusing 0.9% normal saline (NS) at 100cc/hour pre and 15 minutes post procedure, and performing orthostatic blood pressures after the recovery period was completed. The incidence of post-procedural complications of consecutive patients before and after the adoption of the nursing intervention was studied.From July to December 2018, 19 patients underwent fiducial marker placement without any standard post-procedure nursing intervention. One patient experienced projectile vomiting and 6 patients experienced a syncopal episode during the recovery period requiring further medical management. None of these patients had any cardiac or syncopal history noted. From January to August 2019, 19 patients underwent fiducial marker placement with post-procedure nursing intervention. No vasovagal or syncopal episodes were noted in this group.A nursing protocol with a recovery period for patients and the administering normal saline during prostate fiducial marker placement was shown to reduce the incidence of immediate post-procedure complications. Further evaluation of this intervention in larger patient populations is warranted. The impact of hydrogel placement also warrants further investigation.