Veno-occlusive disease nurse management: development of a dynamic monitoring tool by the GITMO nursing group

Abstract

Veno-occlusive disease (VOD) is a complication arising from the toxicity of conditioning regimens that have a significant impact on the survival of patients who undergo stem cell transplantation. There are several known risk factors for developing VOD and their assessment before the start of conditioning regimens could improve the quality of care. Equally important are early identification of signs and symptoms ascribable to VOD, rapid diagnosis, and timely adjustment of support therapy and treatment. Nurses have a fundamental role at the stages of assessment and monitoring for signs and symptoms; therefore, they should have documented skills and training. The literature defines nurses’ areas of competence in managing VOD, but in the actual clinical practice, this is not so clear. Moreover, there is an intrinsic difficulty in managing VOD due to its rapid and often dramatic evolution, together with a lack of care tools to guide nurses. Through a complex evidence-based process, the Gruppo Italiano per il Trapianto di Midollo Osseo (GITMO), cellule staminali emopoietiche e terapia cellulare nursing board has developed an operational flowchart and a dynamic monitoring tool applicable to haematopoietic stem cell transplantation patients, whether they develop this complication or not.

Diagnosis and Treatment of VOD/SOS After Allogeneic Hematopoietic Stem Cell Transplantation

“…Daily reports of several parameters, such as abdominal circumference, weight, and diuresis, are recommended (13,41). The nurse group of the Italian Society of Bone Marrow Transplantation elaborated an operational flowchart for a dynamic nursing monitoring of patients with suspected or proven VOD/SOS (82). Supportive care includes a careful evaluation of fluid balance with diuretics, as well as all therapeutic measures aimed to reduce the discomfort of massive ascites, pleural effusion, hypoxia, pain, and renal dysfunction such as paracentesis, thoracentesis, oxygen therapy according to the respiratory parameters, analgesic therapy, hemodialysis, or hemofiltration.…”

Nursing role in the assessment and care of hepatic sinusoidal obstruction syndrome patients: a consensus paper by the “Gruppo Italiano Trapianto di Midollo Osseo”

“…Given that a careful recognition of signs and symptoms is fundamental for early diagnosis [10,37], it was agreed by the group that SOS management requires specifically trained nurses. BMT nursing staff should approach patients using a proactive model of care [27,31,32].…”

“…The main RFs for SOS development are summarized in Table 2. Assessment interventions cannot always be performed simultaneously by doctors and nurses but the sharing of results amongst health care professionals seems very important [31]. The EP agreed that it is fundamental for nurses to participate at the pre-transplant risk assessment process and to know the results and decisions taken in order to reduce transplantation risks before patient admission into the BMT unit.…”

“…These protocols are not focused on endothelial injuries. However, it seems fundamental that nurses know how to carry out a pre-transplant assessment and how to adapt the monitoring baseline intensity to the patient's risk level proactively [31].…”

“…Early recognition, diagnosis and treatment are crucial aspects to limit SOS' severity increasing chances of success [22][23][24][25]. Some authors state that nurses should be involved in a pre-transplant risk assessment to optimize risk factor detection and that they have a crucial role in the early detection of signs and symptoms during and after hospitalization [26][27][28][29][30][31][32][33]. Many clinical issues have been investigated; nursing issues have been studied as well, but there is a lack of specific topics such as assessment, monitoring techniques and care standards.…”