Analysis of the feasibility of early hospital discharge after autologous hematopoietic stem cell transplantation and the implications to nursing care

Abstract

IntroductionAutologous hematopoietic stem cell transplantation is a conduct used to treat some hematologic diseases and to consolidate the treatment of others. In the field of nursing, the few published scientific studies on nursing care and early hospital discharge of transplant patients are deficient. Knowledge about the diseases treated using hematopoietic stem cell transplantation, providing guidance to patients and caregivers and patient monitoring are important nursing activities in this process. Guidance may contribute to long-term goals through patients’ short-term needs.AimTo analyze the results of early hospital discharge on the treatment of patients submitted to autologous transplantation and the influence of nursing care on this conduct.MethodsA retrospective, quantitative, descriptive and transversal study was conducted. The hospital records of 112 consecutive patients submitted to autologous transplantation in the period from January to December 2009 were revisited. Of these, 12 patients, who remained in hospital for more than ten days after transplantation, were excluded from the study.ResultsThe medical records of 100 patients with a median age of 48.5 years (19–69 years) were analyzed. All patients were mobilized and hematopoietic stem cells were collected by leukapheresis. The most common conditioning regimes were BU12Mel100 and BEAM 400. Toxicity during conditioning was easily managed in the outpatient clinic. Gastrointestinal toxicity, mostly Grades I and II, was seen in 69% of the patients, 62% of patients had diarrhea, 61% of the patients had nausea and vomiting and 58% had Grade I and II mucositis. Ten patients required hospitalization due to the conditioning regimen. Febrile neutropenia was seen in 58% of patients. Two patients died before Day +60 due to infections, one with aplasia. The median times to granulocyte and platelet engraftment were 12 days and 15 days, respectively, with median red blood cell and platelet transfusions until discharge of three and four units, respectively. Twenty-three patients required rehospitalization before being discharged from the outpatient clinic.ConclusionThe median time to granulocyte engraftment was 12 days and during the aplasia phase few patients were hospitalized or suffered infections. The toxicity of the conditioning was the leading cause of rehospitalization. The nursing staff participated by providing guidance to patients and during the mobilization, transplant and outpatient follow-up phases, thus helping to successfully manage toxicity.

Evaluation of Quality of Life and Care Needs of Turkish Patients Undergoing Hematopoietic Stem Cell Transplantation

“…Patients with worse functional status and those who had complications associated with allogeneic hematopoietic stem cell transplantation had worse quality of life scores and more severe symptoms [7, 18, 24]. In this study, patients who returned to the hospital for treatment after hematopoietic stem cell transplantation had worse quality of life after discharge than those who had outpatient follow-up.…”

Nursing interventions in autologous stem cell transplantation for autoimmune diseases

“…This was not observed in the T1D patients, even after exhausting the available therapeutic arsenal against nausea. Thus, there is an opportunity to improve patient care, as to control gastrointestinal manifestations without the aid of steroids is a still challenging (Barban et al., 2014; Fox‐Geiman et al., 2001).…”

Perfil Clínico De Crianças Submetidas a Transplante De Células-Tronco Hematopoiéticas

“…No que cabe à alta hospitalar, sua precocidade tem sido uma tendência, pois se pode atender maior número de pacientes e reduzir a espera pelo transplante (24) . Os dados deste estudo não possibilitam avaliar a precocidade da alta, contudo, no referido STMO existe a modalidade de internação hospital dia, fato que elevou o quantitativo de pacientes em acompanhamento simultâneo pós-alta, bem como a demanda de cuidados.…”

“…Com relação ao uso dos hemocomponentes, além das reações transfusionais, deve-se pensar no aumento dos custos institucionais em virtude dos processos necessários previamente à transfusão em pacientes imunodeprimidos. Em estudo com adultos em pós-TCTH autólogo, o número médio de transfusões de concentrado de hemácias foi de três unidades e quatro concentrados de plaquetas (24) . No presente estudo o resultado médio foi de cinco hemotransfusões, mas por tratar exclusivamente de TCTH em crianças torna-se difícil a comparação com a literatura, que não prioriza este grupo de pacientes.…”