Pediatric Febrile Neutropenia

Congrats on your upcoming graduation! I work on a pediatric floor where we take care of all sorts of patients, including oncology. When we have a febrile neutropenia, our peds oncologist cals the residents to make them aware of the admission and the resident tells us. We go ahead and have the room ready, hopefully in an isolation room on our oncology hall (if a bed is available on that hall). Not often do we have febrile neutropenia from the ED b/c parents are informed to call the oncologist if the temp (oral or axillar ONLY...NO RECTAL!!!) is greater than 100.4 and then they are directly admitted. If they do come into the ED, the procedure is the same. When they get to the floor, we access their mediports (if they have one) and our policy states to have abx running in 30 minutes. Parents are given EMLA as a prescription so the docs tell them to go ahead and put the EMLA on the port site before they leave for the hospital to take away the ouchie. We don't have the time to wait for EMLA to work once they get here b/c it is more important to get the meds and labs. We culture the line and sometimes do a peripheral culture as well. We have a peds satellite pharmacy on the floor so antibiotics are available very quickly. Theycan't be ready before the patient arrives b/c everything is weight based and we must have an accurate weight (not guessing from mom or dad) to draw the meds. But the pharmacy works very well to make these meds the priority.

Can you think of a dirtier place for a neutropenic kid to be than in the ED? Especially in the waiting room?? Ugggh...I would hate to think what kind of bugs are crawling round! We have had a couple of instances lately where a peds nurse has been called to the ED to access a port. I agree...I think it is just more effective to go ahead and admit them and we will do it here if we have a bed ready. And if we don't have a bed ready, we have ways of working around that too. It may be unfair to say, but we almost give preferential treatment to sickle cell and oncology patients with fevers. They have to potential to be the most unstable patients. Sickle cell kids with fever are pretty much treated the same as an oncology kid with a fever on our floor. They can go into crisis and end up with a fatal acute chest in hours. We had a kid a few months ago with sickle cell who was admitted to the floor, sent to PICU after a few hours due to respiratory distress, and died about 30 minutes later, no joke.