Neupogen

Published

Hi, I am an new RN and just got hired into a chemotherapy clinic. First off, it is sink or swim...no orientation and not really helpful people, doctors are snobs and nurses are all STRESSED OUT. It is my foot in door job :eek:

I am desperately trying to learn my job outside work time. So I need to give a drug called Neupogen, a G-CSF med. I cannot seem to find online or anywhere WHY the drug has to be given 24hours after chemo. Does anyone know the reason. I just tell my patients it has to be, but they ask why? Thanks :nurse:

Specializes in CRITICAL CARE.

ignore my last post, just re-read your question -_-. i'm assuming it's because of the half-life of chemotherapeutics? you wouldn't want to be killing actively proliferating neutrophils

Up Vote Up Vote ×
Specializes in ICU, ED, PICC.

Isn't neupogen given IM?

I think that patients who are immunocompromised aren't allowed to have any 'invasive' procedures, and that includes IMs and new IVs. The opening in the skin may be a route for bacteria to get in. So that's what maybe the 24 hours is for... because right after chemo the patient may be immunocompromised. That may be wrong, but thats just my critical thinking.

OR there might be a reaction between the chemo and neupogen. Since neupogen is a cell-stimulating drug, the chemo might just counteract its effects.

Ask the doctor next time he's around. I'm sure he wouldn't mind answering your question.

Up Vote Up Vote ×
Specializes in Oncology; medical specialty website.
Isn't neupogen given IM?

I think that patients who are immunocompromised aren't allowed to have any 'invasive' procedures, and that includes IMs and new IVs. The opening in the skin may be a route for bacteria to get in. So that's what maybe the 24 hours is for... because right after chemo the patient may be immunocompromised. That may be wrong, but thats just my critical thinking.

OR there might be a reaction between the chemo and neupogen. Since neupogen is a cell-stimulating drug, the chemo might just counteract its effects.

Ask the doctor next time he's around. I'm sure he wouldn't mind answering your question.

It's given sc.

Giving it early reduces the efficacy of the drug.

I've never heard that you can't have invasive procedures, including IMs and IVs, after chemo. We frequently have to give its. hydration post-chemo.

Up Vote Up Vote ×
Specializes in Vents, Telemetry, Home Care, Home infusion.

moved to our oncology nursing forum --see threads here.

accepting a position that you are not qualified for just to get the foot in the door can backfire quickly if one is not provided with proper orientation.

onus is on the rn to speak up to ensure safe practice. need to meet with your manager and discuss need for oriention to prevent harm to your patients and to your brand spanking new rn license.

time to break out the nursing textbook and review principles of chemo administiation and major side effects along with internet search since work not providing you with orientaion. oncology nursing is a very high risk practice area, don't want to see you get thrown under the bus,

there should be a policy and procedure book that should become your new bible..insisit on getting orientation on chemo administration, facility general med regimen proticols and have time to review p+p.

from: oncology nurses society

neutropenia

neutropenia is defined as a decrease in the number of circulating neutrophils (a type of white blood cell) in the blood. neutrophils are also called polymorphonuclear segmented cells, or segs, or polys, and make up about 60% of the body’s circulating white blood cells. neutrophils are the white blood cells that respond first to infections or viruses in the body, and are key to maintaining good health (nirenberg, et al., 2006).

causes of neutropenia

this audio with slides provides a brief overview of the causes of neutropenia related to chemotherapy and other causes.

neutropenia: state of the knowledge, part i

this article reviews neutrophil physiology, consequences of chemotherapy-induced neutropenia, risk assessment models, national practice guidelines, the impact of febrile neutropenia and infection.

cyclic chemotherapy suppresses the normal production and

subsequent availability of neutrophils to fight infection, which

impairs the body’s natural ability to fight infection. usually,

the white blood cell nadir from cyclic combination chemotherapies

is 7–14 days from the chemotherapy administration.

the effect on bone marrow’s ability to maintain production

of an adequate amount of neutrophils may result in severe

neutropenia with or without fever. bodey, buckley, sathe, and

freireich (1966) were the fi rst to demonstrate that the severity,

depth, and duration of neutropenia correspond with the risk

of infection and death (see figure 1).

the introduction of exogenous hematopoietic colony stimulating

factor (csf) has been the single most useful

pharmacologic intervention in reducing the overall adverse

events associated with neutropenia. in a meta-analysis of

13 studies, clark, lyman, castro, clark, and djulbegovic

(2005) showed that the length of hospital stay was signifi -

cantly reduced for fn and the time to neutrophil recovery

improved when csf was used. in addition, improvement

in infection-related mortality with the use of csf had been

suggested (clark et al.).

calculating the absolute neutrophil count (anc)

this audio with slides provides directions for and examples of calculating the absolute neutrophil count (anc).

risk factors for developing neutropenia

read a summary of risk factors for developing chemotherapy-induced neutropenia.

chemotherapy drugs - list of cancer chemo therapy drugs side effects, precautions and nursing interventions.

cancer resources from oncolink | treatment, research, coping ...

see their sections: nurses' notes

this section is dedicated to organizing resources for nurses, including new therapies, disease information, drug information and patient handouts.

[color=#152864]oncolink rx

[color=#42426b]oncolink rx regimen printer

print handouts for chemotherapy regimens with just one click!

teaching sheets on most of the medications used in cancer treatment, covering how each drug is given, how they work, and common side effects. sheets can be printed to be used as handouts.

[color=#42426b]filgrastim (neupogen®, g-csf)

Up Vote Up Vote ×
Specializes in ICU, ED, PICC.
It's given sc.

Giving it early reduces the efficacy of the drug.

I've never heard that you can't have invasive procedures, including IMs and IVs, after chemo. We frequently have to give its. hydration post-chemo.

Thank you for letting me know. I had minimal experience in oncology while I was in nursing school.

You learn something new every day :)

Up Vote Up Vote ×
Specializes in Longterm/Rehab and Hematology/Oncology.

thanks everyone..that helped...and i did ask one of the NP's and she basically said all the above!!

Up Vote Up Vote ×
Specializes in Emergency.

I used to work in-pt oncology and we would also frequently give it IV.

Up Vote Up Vote ×

I found this document on amgen's website for prescribing neupogen

on page 13 and 14 it has a brief explanation of the reasoning behind not giving neupogen within 24 hours before or after cytotoxic chemotherapy.

Sounds to me like they think that in the first 24 hours the chemo would damage the newly growing wbc's and render it useless if not harmful.

http://pi.amgen.com/united_states/neupogen/neupogen_pi_hcp_english.pdf

Hope this helps. Thanks for motivating me to find this. Now I know too!

Up Vote Up Vote ×
+ Join the Discussion