Nursing care of the granulocyte donor for pediatric stem cell transplant patients

Abstract

Infection continues to be the leading cause of morbidity and mortality in patients with severe and sustained neutropenia defined as an Absolute Neutrophil Count of <500/uL. Cesaro et. al (2003) concludes that “granulocyte transfusion therapy is potentially useful when the severity of the infection and the host’s immunodeficiency make any other antimicrobial therapy ineffectual.” The Duke Pediatric Blood and Marrow Transplant program uses granulocyte transfusion therapy for persistently neutropenic patients with severe infections and for patients who must undergo a second bone marrow transplant. Donors are required to go through blood donor questionnaires and blood testing to ensure the safety of both the donor and the recipient per FDA donor regulations effective 5/25/2005. When possible, a CMV negative donor is selected. Once a donor is selected (usually a relative of the patient) a double lumen pheresis catheter is placed for the duration of the donation. The donor is primed with G-CSF 10 mcg/kg twice weekly. Granulocytes are harvested by pheresis 14 to 16 hours post G-CSF dosing, irradiated, divided into 3 doses, and administered IV to the patient daily × 3With 2 pheresis per week, the recipient receives granulocytes 6/7 days. Nurse coordinators and staff nurses on the inpatient transplant unit collaborate to provide the majority of care and education to the granulocyte donors in order to provide consistency of care for families. The transplant patient’s nurse is responsible for monitoring and maintaining the pheresis catheter and for administering G-CSF by injection to the donor. The nurse must also educate the donor about possible side effects of G-CSF therapy and granulocyte donation as well as ways to prevent these side effects. The purpose of this poster will be to (1) educate the learner about the nurse’s responsibility in caring for the granulocyte donor; (2) describe the standard operating procedure for daily care of the pheresis catheter; (3) describe the standards for dosing, frequency, and administration of GCSF; (4) provide education about the possible side effects of granulocyte donation and how they may be prevented; (5) describe the potential emotional implications for the donor. Infection continues to be the leading cause of morbidity and mortality in patients with severe and sustained neutropenia defined as an Absolute Neutrophil Count of <500/uL. Cesaro et. al (2003) concludes that “granulocyte transfusion therapy is potentially useful when the severity of the infection and the host’s immunodeficiency make any other antimicrobial therapy ineffectual.” The Duke Pediatric Blood and Marrow Transplant program uses granulocyte transfusion therapy for persistently neutropenic patients with severe infections and for patients who must undergo a second bone marrow transplant. Donors are required to go through blood donor questionnaires and blood testing to ensure the safety of both the donor and the recipient per FDA donor regulations effective 5/25/2005. When possible, a CMV negative donor is selected. Once a donor is selected (usually a relative of the patient) a double lumen pheresis catheter is placed for the duration of the donation. The donor is primed with G-CSF 10 mcg/kg twice weekly. Granulocytes are harvested by pheresis 14 to 16 hours post G-CSF dosing, irradiated, divided into 3 doses, and administered IV to the patient daily × 3With 2 pheresis per week, the recipient receives granulocytes 6/7 days. Nurse coordinators and staff nurses on the inpatient transplant unit collaborate to provide the majority of care and education to the granulocyte donors in order to provide consistency of care for families. The transplant patient’s nurse is responsible for monitoring and maintaining the pheresis catheter and for administering G-CSF by injection to the donor. The nurse must also educate the donor about possible side effects of G-CSF therapy and granulocyte donation as well as ways to prevent these side effects. The purpose of this poster will be to (1) educate the learner about the nurse’s responsibility in caring for the granulocyte donor; (2) describe the standard operating procedure for daily care of the pheresis catheter; (3) describe the standards for dosing, frequency, and administration of GCSF; (4) provide education about the possible side effects of granulocyte donation and how they may be prevented; (5) describe the potential emotional implications for the donor.