Neck Lymph Node Excision

Setting

  • WIPER  (wash hands, introduce yourself, permission, expose patient, reposition)
  • Ask if the patient is happy to see you

Perception

  • Check what the patient understands so far
  • What symptoms are they having and what treatments have they tried so far
  • Offer options including surgery and alternatives
Invitation 
  • Ask if they would like to know more about the operation

  • Ask permission to take consent

  • Explain you will outline the procedure, alternatives, risks and benefits, recovery time.

  • ‘If at any point you have any questions feel free to interrupt me, but I’ll also ask you afterwards if you have any questions’

 

Knowledge

  • Explain procedure

  • Draw diagram

  • Explain alternatives

  • Intended benefits

  • Potential risks and complications

    • With any operation, risk of bleeding, infection, pain, risk of GA – anaesthetist will be able to go through in more detail. See General Risks below

    • Also specific risks associated with this operation. 

      • Need for neck drain

      • Problems with drain (blockage, stuck)

      • Weakness to lower lip

      • Weakness to tongue

      • Numbness of earlobe

      • Chyle leak

    • Individual risks to patient

 

Post op

  • Most likely to be day case procedure

  • May have a drain which will be removed later that day or next day

  • Time off work – give sick note

  • Contact department/attend A&E if: Increasing difficulty breathing, neck swelling, fever, pain not responding to analgesics

 

Follow up advice

  • See back in clinic in 2-3 weeks with histology

 

Summary

  • Summarise consultation

  • Offer opportunity to ask questions

  • Offer patient information leaflet

  • Thank patient, wash hands and close

 

General Risks

  • Bleeding and bruising

  • Infection

  • Pain

  • Scar

  • Risk of general anaesthesia

  • Further surgery

  • Return to theatre

  • Recurrence

  • Suboptimal outcome

  • Numbness

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