THE FORUM

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SVC SYNDROME

Superior Vena Cava Syndrome (SVCS):


Compression or invasion of the superior vena cava by tumor, enlarged lymph nodes, intraluminal thrombus that obstructs venous circulation, or drainage of the head, neck, arms, and thorax. Typically associated with lung cancer,

SVCS can also occur with lymphoma and metastases. If untreated, SVCS may lead to cerebral anoxia (because not enough oxygen reaches the brain), laryngeal edema, bronchial obstruction, and death.


Clinical picture:


Gradually or suddenly impaired venous drainage giving rise to:

• Progressive shortness of breath (dyspnea), cough, and facial swelling

• Edema of the neck, arms, hands, and thorax and reported sensation of skin tightness and difficulty swallowing

• Possibly engorged and distended jugular, temporal, and arm veins

• Dilated thoracic vessels causing prominent venous patterns on the chest wall

• Increased intracranial pressure, associated visual disturbances, headache, and altered mental status

Diagnostic:


Diagnosis is confirmed by

• Clinical findings

• Chest x-ray

• Thoracic CT scan

• MRI

•Intraluminal thrombosis is identified by venogram.


Medical


• Radiation therapy to shrink tumor size and relieve symptoms

• Chemotherapy for radiation-resistant tumor (eg, lymphoma or small cell lung cancer) or when the mediastinum has been irradiated to maximum tolerance

• Anticoagulant or thrombolytic therapy for intraluminal thrombosis

• Surgery (less common), eg, vena cava bypass graft (synthetic or autologous) to redirect blood flow around the obstruction

• Supportive measures such as oxygen therapy, corticosteroids, and diuretics

Nursing management:


• Identify patients at risk for SVCS.

• Monitor and report clinical manifestations of SVCS.

• Monitor cardiopulmonary and neurologic status.

• Facilitate breathing by positioning the patient properly. This helps to promote comfort and reduce anxiety produced by difficulty breathing resulting from progressive edema.

• Promote energy conservation to minimize shortness of breath.

• Monitor the patient’s fluid volume status and administer fluids cautiously to minimize edema.

• Assess for thoracic radiation-related problems such as dysphagia (difficulty swallowing) and esophagitis.

• Monitor for chemotherapy-related problems, such as myelosuppression.

• Provide postoperative care as appropriate.