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Breast Expander Fill Procedure (102.133)

Breast Expander Fill Procedure (102.133) - Policies, Clinical, UWMF Clinical, UWMF-wide, Clinical Policies and Procedures, Transformations

102.133

1
UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
POLICY AND PROCEDURE

TITLE: Breast Expander Fill Procedure

Effective Date: March, 2009 Approval: See Authorization
Supersedes Policy: None Contact: Transformations Clinic
Reviewed February 2012

PURPOSE: The purpose of this policy is to give guidance on the proper administration of breast expander solution at the
UWMF Transformation Clinic.

DEFINITIONS
Tissue-expander: a device, similar to a water balloon, that is placed in the body so that tissue expansion may be
performed. Tissue expanders are made from a silicone compound similar to that used in saline breast implants. The exact
size and shape of the expander is determined by the size, shape and nature of the defect requiring reconstruction. The
tissue-expander is placed during a surgical procedure in a deflated or largely deflated state.
Tissue-expander fill: After the surgical incision has adequately healed (ordinarily about two to three weeks) the expander
is gradually inflated in your surgeon's office through regular injections of saline solution by way of a small needle placed
through the skin.
POLICY: The UW Health Transformations staff will utilize the following guidelines to properly assess the patient who
will be receiving a breast expander, to properly administer the solution, and to provide post-injection instructions to
patients.

SUPPLIES:
Alcohol wipes, 22G 1 ½ needle, Marking Pen, 250 cc Saline IV bag or 50 ml bottles of Saline, Magnet finder or
Center scope, 1 Universal Fill Kit #30-00033 (Braun) or IV tubing, stop cock and 60 cc syringe

PROCEDURE:
1. Check provider’s order and clarify order and any inconsistencies.

2. Access the operative report to get the size, type and location of the expander.

3. Wash hands and gather equipment.

4. Introduce yourself and identify the patient. Include date of birth. Verify allergies.

5. Explain procedure to the patient, and have patient change into a gown.

6. Removing any dressings or under garments.

7. Wash hands.

8. Prime tubing with saline or fill syringe with saline depending on what process you have chosen to use to fill
expander.

9. Assess breast incisions and general health of skin.

10. Wipe off Magnet finder/Centerscope with alcohol.

11. Move magnet over general area where port is located.

12. Go from right side than left side and than from top and from the bottom.

2

13. Press down firmly on locator to mark the skin.
NOTE: A skin marking pen may be used for landmarks.

14. Wipe off skin with alcohol wipe.

15. Using aseptic technique insert needle into skin thru port until the needle hits a firm metal back.
NOTE: Do not push to fast or hard as could bend needle or metal backing.

16. Slowly inject saline.
NOTE: Amount will depend on patient comfort and previous amounts.
If this is the first injection – amount of saline may be around 70 to 100cc.
Subsequent amounts will be approximately 50 to 100cc.

17. Assess patient’s comfort level during injection of saline.
NOTE: Watch for any signs of sign blanching (too much fluid instilled).

18. Remove needle, apply pressure, and cover injection site with Bacitracin and a band aid.

19. Patient Discharge Instructions:
Recommend Tylenol or Ibuprofen before next injection and for discomfort afterward.
Inform patient that it is possible the expander may be off-center or oblong in shape as they are not perfectly
round to begin with. Expander may also shift location as well.
Review signs of cellulitis with the patient (redness, swelling; fever). Inform patient if cellulites occurs – it
requires immediate attention. Patient to call Transformations @ 608-836-9990.
Inform patient to contact their primary care physician for issues unrelated to their injection.

20. Documentation: (in Progress Notes section of HealthLink)in the patient’s record:
Patient education prior to procedure
the amount of saline instilled per injection.
NOTE: Keep a running total of the amount of saline injected. Maximum amount depends on size of
expander and individual patient. Each person is different based on size, skin type and level of comfort.
How patient tolerated procedure
Discharge Instructions
Follow-up appointments (if needed)


WRITTEN BY: Lisa Gretebeck, R.N. UW Health Transformations
REVISED BY: Carol Decker, RN, MSN, Clinical Staff Educator
REVIEWED BY: Venkat Rao, MD UW Health Transformations, 2009
Lisa Gretebeck, RN, Team Leader, UW Health Transformations Clinic

AUTHORIZATION AND ANNUAL REVIEW:


Medical Director, Transformations Clinic Date



Medical Director Date