Perioperative nursing coordination and complication management in Yttrium-90 radioactive microsphere therapy for hepatocellular carcinoma

Abstract

To explore the perioperative nursing protocols and complication management strategies for hepatocellular carcinoma (HCC) patients undergoing Yttrium-90 (Y-90) radioactive microsphere therapy. Methods: A retrospective analysis was performed on clinical data from 15 HCC patients treated with Y-90 radioactive microspheres at Qilu Hospital of Shandong University between December 2024 and April 2025. A structured, multidisciplinary perioperative nursing protocol was implemented, consisting of: (1) Preoperative multidisciplinary evaluation including nutritional risk screening (NRS-2002), radiation dosimetry assessment, and vascular anatomy verification; (2) Intraoperative coordination with specific steps for patient positioning, vascular access establishment, radiation safety measures, and vital sign monitoring; (3) Postoperative dynamic monitoring of vital signs (every 2 h), puncture site condition, laboratory parameters (at 24 and 72 h), and symptom assessment using NRS for pain; (4) Tiered complication management system based on CTCAE v5.0 grading criteria. All 15 patients completed the treatment successfully. The postoperative complication rate was 73.3% (11/15), with manifestations including abdominal pain (five cases), fatigue (three cases), leukopenia (three cases), thrombocytopenia (two cases), and low-grade fever (one case), all complications resolved with appropriate symptomatic management. No severe adverse events such as radiation-induced liver injury or significant myelosuppression occurred. Standardized perioperative nursing workflows, comprehensive radiation protection protocols, and an early-warning system for complications are essential to enhancing the safety of Y-90 microsphere therapy.