Bone Marrow Transplant

blondy2061h, MSN, RN · Oct 13, 2009

My unit is 100% BMT. I typically have 3 patients on nights. I come in, get report, go through orders and results from the day. I read the MD's and NP's charting on them from that day. I look and make sure all labs I need are ordered (we have standing orders for things like glucose checks, electrolyte checks, coags, CBCs, etc).

Around 8pm I start passing 9pm meds. Many of our patients have hourly meds. It's not unusual for me to have meds due on at least one of my patients every hour throughout the night. I'd say 75% of the meds are IV. Tons of IV antibiotics, Cellcept, Tacrolimus, Cyclosporine, IV electrolyte replacement (done based on labs q12h), lasix, antiemetics, steroids, etc.

We give chemotherapy with a fair amount of frequency (as pre-transplant prep).

Most of our patients are on TPN.

We do run cardiac drips on my floor. This includes a fair amount of pressors when patients are septic. We also will run things like amiodorone and cardizem for arrhythmias, and occasionally do a drip for HTN. We also do insulin drips, occasional antibiotic drip, occasional continuous chemo, occasional continuous Tacro, occasional continuous abx. Amicar drips are another drip we see fairly often. And of course opiate drips.

Expect to give tons of blood products. Red blood cells and platelets are our friends. We also give albumin and FFP with some regularity.

We do vitals at least every 4 hours and I&Os at least every 4 hours.

Expect to have a large amount of patients on isolation. We've had times our whole unit was on isolation.

The hardest part about BMT nursing is managing lines. All of your patients will have central lines. Some will have more than one central line. Many will have a central line on one side of their chest and a mediport on the other. Some get femoral central lines and chest central lines. Some get a PICC and a central line. I often have patients with 6+ lines of central access and still have a line crunch. If your patient is getting 2 IV immune suppressants, one of those will be running at nearly all times. These generally have to run alone. Most patients have TPN. Add in electrolyte replacements, all of the antibiotics, any drips, and you're in for a fun night of checking compatibilities and switching lines over. You need to be meticulous with planning out your shift med wise and keeping your pumps and lines organized.

You'll draw more cultures than you can shake a stick at. You'll never start an IV and rarely draw blood peripherally.

One thing that's unique about BMT nursing is that your patients will be much younger than your typical oncology patient. As such, when they're feeling well, they're often quite independent and fun to be around. This is a huge plus in my mind.

Thorough assessments are huge. Things can go from good to very bad remarkably quickly. It keeps you on your toes.

For me, my nights vary wildly from the very quiet (dare I say boring?) to the can't-keep-up ones.

You'll get to know your patients very well. They'll be there for a looooonnnnnngggg time. Great if you like your patients. Bad if you don't. You'll have frequent fliers that are constantly getting readmitted.

Sepsis, electrolyte disturbances, hemorrhage, DIC, arrhythmias, anemia, thrombocytopenia- those are the main fun things we get to frequently deal with.

Keep in mind that anyone going into transplant has all of their other medical conditions they're bringing in with them. These will all get worse as they get overall more unstable. As a result, you'll deal with more variety in disease condition than you may thing.

Good luck! BMT is a frustrating and sad, but very rewarding field.

NurseLay · Oct 13, 2009

Thanks for taking out the time to respond! I really appreciate it. I shadowed and they only had 10 patients and I was bored, but I was told that since June they have been full with 19-21 patients and all of the things you described. The only thing is that they do not take cardiac drips or anything for HTN, and I forgot to ask what do they do in a situation where someone goes into an uncontrolled afib rhythm or something like that. Anyway, I am planning on shadowing again and hopefully the next time I'll see some excitement. Thanks again for responding!