Febrile Neutropenia

[ittybabyRN, RN]

I am a senior nursing student (graduation less than 3 weeks!) and have been doing my senior internship on a pediatric medical-surgical unit of a large hospital. This unit takes all pediatric patients including oncology patients. There are currently no policies in place for the management of febrile neutropenia (besides standard neutropenic precautions, no fresh flowers, fruits/veggies, private room etc). Per request of the nursing manager I am doing my final research project for the unit on the management of febrile neutropenia. I have found some articles suggesting parents call ahead when coming to the hospital and arrange for a direct admit, antibiotics started within 30 minutes of arrival and standard antibiotic doses kept on the unit for stat infusions. I was wondering if anyone could share their institutions policies on this subject and/or any good resources or articles to take a look at.

Thanks!

[NeoPediRN]

I actually just had my first encounter with this situation this week. The patient becomes first priority and gets ASAP doctor appointment and direct admit if necessary...try really hard to bypass the ER. We generally use Rocephin as the empirical antibiotic. We also institute reverse precautions and the it helps if the parent keeps a home supply of masks so the patient can have one on when she/he walks through the door. Neutropenic diet and push lots of fluids. Also try hard not to have to insert an IV if they don't have an accessed port as it can be an invitation for bacteria. Other than that, there's not much else I'm aware of.

[ittybabyRN, RN]

Thanks for the input!

It's really interesting to see the variations in practice...and the obvious need for some sort of standards, we had a kid last week went to the ER because he had an out of hospital doctor who wanted to evaluate him there, problem was none of the ER nurses could access his port so we had to send one of the pedi nurses to do it in the ER...should have been sent straight up instead of sitting around in there, other times we get direct admit, depends on the Doc