Neutropenia

 Laurl at ONS 

Welcome to the ONS Hot Topic Chats! Today’s expert is Rebecca Donohue, who will be talking with us about any and all questions you have regarding Neutropenia. Welcome Rebecca!

 Rebecca Donohue 

Do you have any burning questions?

 Rebecca Donohue 

Where are you from? Work inpatient or outpt?

 oncnurse 

In Massachusetts- in education

 mcsinc2001@shaw.ca 

I have a training program with an oncology nurse where we teach estheticians to work with cancer patients in the spa surrounding - so I have an esthetic background, and learning all about this.

 mcsinc2001@shaw.ca 

Just want to really understand about neutropenia and the differences between this and thrombocytopenia.

 Rebecca Donohue 

I think it is important to understand neutropenia in your type of work.

 Rebecca Donohue 

Chemotherapy has an effect on the bone marrow.

 mcsinc2001@shaw.ca 

Okay

 Rebecca Donohue 

Chemo works by killing of fast growing cells -- since cancer is a fast growing cell.

 Rebecca Donohue 

Unfortunately this affects other fast growing cells such as those in the bone marrow.

 Rebecca Donohue 

There are 3 different cell types effected: white blood cells, red blood cells and platelets.

 Rebecca Donohue 

Platelets are the part of the blood that effects clotting, or stops bleeding.

 Rebecca Donohue 

Low platelets - thrombocytopenia - would definitely be a concern in your business.

 Rebecca Donohue 

Low red cells mean anemia and not such a concern.

 Rebecca Donohue 

However, white blood cells are our immune system and when low this is neutropenia.

 Rebecca Donohue 

Patients that are neutropenic are at increased risk for infection.

 Rebecca Donohue 

Infection is the most serious complication of chemotherapy.

 Rebecca Donohue 

I think it would be very important to know if your patients are currently receiving chemotherapy.

 mcsinc2001@shaw.ca 

Would you say Rebecca with regards to my business the risk is from broken skin alone or other things?

 Rebecca Donohue 

What types of procedures do you do?

 steph199 

We use masks and gloves

 mcsinc2001@shaw.ca 

Facials (which include extractions which I can say is a definite no), massage...so many to list, but I'm seeing where this goes with the other treatments.

 mcsinc2001@shaw.ca 

Oh yes, gloves and masks for sure

 Rebecca Donohue 

Any injections, skin peels or other procedures that break the skin (our line of defense against infection) would be contraindicated in the neutropenic pt.

 mcsinc2001@shaw.ca 

Yep, can see that

 Rebecca Donohue 

The concern is if any procedure done on the pt will place her at risk.

 steph199 

In the hosp setting, do you have isolation pts being care fore along with neutrapenic pts?

 Rebecca Donohue 

This is a common question.

 mcsinc2001@shaw.ca 

Would you say not to do a facial or massage or any other treatment where no risk of breaking the skin is possible?

 Rebecca Donohue 

The recommendation is that the infected and neutropenic pt should be separated.

 Rebecca Donohue 

I work in the outpt setting where this is difficult however.

 Rebecca Donohue 

Related to massage -- this is not contraindicated with neutropenia, but it would be with thrombocytopenia.

 Rebecca Donohue 

Pt with low platelets is at increased risk of bruising or bleeding.

 Rebecca Donohue 

Related to isolation in outpt, I would suggest trying to separate these pts as much as possible.

 Rebecca Donohue 

I also would suggest having different nurses caring for each pt.

 mcsinc2001@shaw.ca 

Surely patients that have thrombocytopenia are cautioned about what they can and cannot do?

 Rebecca Donohue 

Pt should be aware, but may not interpret the teaching they were given, if it was given, to mean no massage.

 mcsinc2001@shaw.ca 

Yes, sometimes interpretation is not always taken accurately by patient.

 mcsinc2001@shaw.ca 

At what point can that patient get a massage - when the low platelet count increases?

 Rebecca Donohue 

Correct, it would be prudent, if you know the pt is on chemo, to ask if they checked with the practitioner to OK massage.

 mcsinc2001@shaw.ca 

Okay, good point

 Rebecca Donohue 

What platelet level is OK is probably up to their practitioner.

 mcsinc2001@shaw.ca 

What sanitation/infection control practices do you recommend for the neutropenic patient?

 Rebecca Donohue 

Cancersymptoms.org is a great pt focused site that may help.

 Rebecca Donohue 

Basic instructions would be to avoid anything that could cause a skin break…

 Rebecca Donohue 

…avoid any person that has an infection.

 mcsinc2001@shaw.ca 

Yep makes sense

 Rebecca Donohue 

…report any fever (>100.4F) to your MD

 Rebecca Donohue 

Avoid anyone that has had a recent vaccine (MMR) and flu nasal spray.

 Rebecca Donohue 

These are vaccines with live viruses.

 mcsinc2001@shaw.ca 

Good info

 oncnurse 

Can you provide the recommendations re: animal exposure for neutropenic pts? Is this evidence based?

 Rebecca Donohue 

The ONS PEP cards advise avoidance with animal feces, saliva, urine, or solid litter box material.

 Rebecca Donohue 

I usually recommend another family member take care of these things.

 Rebecca Donohue 

An animal bite should be cleaned promptly and reptiles should be avoided.

 Rebecca Donohue 

Also, as always good hand hygiene needs to be practiced.

 Rebecca Donohue 

I always discuss keeping animals up to date with their vaccinations.

 oncnurse 

Thanks!

 Rebecca Donohue 

Any other burning questions?

 Rebecca Donohue 

Did I answer your question about isolation?

 mcsinc2001@shaw.ca 

You have answered mine so far....thanks

 steph199 

We instruct our pts to avoid fresh flowers and no fresh fruit, or veggies, stay away from crowds and no visitors that are sick or feeling sick, in the hosp setting, staff entering the room wear masks and gloves or avoid the room, however we are told good hand washing between pts.

 Rebecca Donohue 

All good. The fresh fruits/veggies idea is controversial these days.

 steph199 

So that's permitted at your facility?

 mcsinc2001@shaw.ca 

My question would be on the fresh fruits and veggies too - if well washed - they ought to be healthy and healing for the body and yet on the flip side, they do or may carry bacteria that can cause problems.

 Rebecca Donohue 

We are still fairly old school about this issue. However, I usually tell my neutropenic pt to avoid raw seafood & meat.

 Rebecca Donohue 

Also, when there was a federal recall on an item (pistachios, peanuts) I recommend these are avoided.

 Rebecca Donohue 

The worry with uncooked foods is that there is bacteria that a neutropenic pt could not fight off.

 mcsinc2001@shaw.ca 

Yea but good nutrients are also lost.

 Rebecca Donohue 

This nutrient loss can be made up for, however, infection can kill a patient with not resistance.

 steph199 

I agree

 Rebecca Donohue 

There is some thought that fruits/veg that are peeled (if the inside is not touched) may be OK.

 mcsinc2001@shaw.ca 

Makes sense

 steph199 

Frozen veggies and fruit have a lot of nutrients............

 Rebecca Donohue 

Good point!

 mcsinc2001@shaw.ca 

Just not as tasty ;-)

 Rebecca Donohue 

Frozen is probably blanched and so would be safe.

 Rebecca Donohue 

Other environmental issues include home humidifiers or the need to change the water and filter frequently. Not to mention oxygen humidifiers with the need to change tubing.

 Rebecca Donohue 

As for taste with foods, this is usually different as a result of the chemo anyway.

 steph199 

Right, and at times they have a tough time just getting food down.....out diet depart. works with each pt to find what would be appealing and taste good to them so they will eat.

 mcsinc2001@shaw.ca 

Quite amazing actually - all the various components.

 Rebecca Donohue 

Of all the precautions that can be taken for neutropenic pt teaching good hand washing for them and anyone in contact with this is vital.

 mcsinc2001@shaw.ca 

Do the patients get quite thirsty or is that an individual thing with each one?

 mcsinc2001@shaw.ca 

Please tell me what good hand washing is considered - like 3 x each time for how long, etc?

 Rebecca Donohue 

It is individual, but chemo affects the mucous membranes in the mouth, causing them to dry.

 steph199 

And IV fluids are running to make sure they stay hydrated.

 Rebecca Donohue 

Re: Handwashing: I usually teach them to sing Happy birthday to themselves, slowly while soaping…

 Rebecca Donohue 

…This is the right amount of time. Also remember to teach them to dry well.

 mcsinc2001@shaw.ca 

pat dry or rub dry.

 Rebecca Donohue 

If they are in the hospital IVs work great. At home I remind them that any liquid that is no caffeine or alcohol will hydrate.

 Rebecca Donohue 

If there is no skin problem normal drying with a towel is fine.

 steph199 

We're instructed pat and not to use hot water, causes dry skin and that will crack and then open up site for bacteria.

 Rebecca Donohue 

Good point -- no hot water.

 mcsinc2001@shaw.ca 

Yep, thanks steph199

 Laurl at ONS 

It's about five minutes before our time is up -as you continue to ask questions, please don't forget to take a moment to cut and paste this URL into your browser and take our very brief survey at the end of the chat- we'd love to hear what you think of these chats! The URL is http://research.zarca.com/k/RsTUTRsSUWsXYTXRsPsP

 steph199 

Thanks to all for great information.

 Laurl at ONS 

We really appreciate your insights into this venue and would also love to get ideas for future chats from you!

 Rebecca Donohue 

Thanks to everyone!

 Laurl at ONS 

Any final questions mcsinc?

 mcsinc2001@shaw.ca 

sorry, lost myself - thanks

 mcsinc2001@shaw.ca 

No more questions.....

 Laurl at ONS 

We are still here- did you have any final questions for Rebecca?

 mcsinc2001@shaw.ca 

No, that is helpful to me thanks

 Laurl at ONS 

Thank you Rebecca! The next and final chat with her is tomorrow AM. Please tell your colleagues about it!