Nursing care for patients undergoing hematopoietic stem cell transplantation

Scoping review, whose search was carried out in the MEDLINE, CINAHL and LILACS bases, from June to August 2019, in Portuguese, English and Spanish. We selected 18 publications on the theme.

Results:

The nursing care was related to the phases of the transplantation, namely: conditioning, infusion, harvest, and post-transplantation.

Conclusion:

The specific knowledge of nursing care for patients submitted to hematopoietic stem cell transplantation allows the nurse to recognize complications of this clientele, favoring early interventions and aiming to restore the patient, thus contributing to evidence-based nursing care.

Keywords
Nursing care; Hematopoietic stem cell transplantation/nursing; Bone marrow transplantation

Database	Search strategy	Number of publications
MEDLINE via PubMed^®	“nursing care”[All Fields] AND “bone marrow transplantation “[All Fields] AND ((“2000/01/01”[PDAT] : “3000/12/31”[PDAT]) AND (English[lang] OR Portuguese[lang] OR Spanish[lang]))	16
CINAHL (via EBSCO)	“bone marrow transplantation”AND “nursing care” OR “nursing”	20
LILACS	“tw:(cuidados de enfermagem AND transplante de medula ossea) AND (instance:”regional”) AND ( db:(“LILACS”) AND type:(“article”))	34

Nursing care	Articles
Control of cardiological, renal, hepatic, neurological and hematological toxicity due to conditioning Monitor vital signs Determine fluid balance Daily weighing Administer uroprotective and diuretic agents during cyclophosphamide infusion (prevention of hemorrhagic cystitis) Measure abdominal circumference daily	Lima et al.,⁽⁹9. Lima K, Bernardino E. Nursing care in a hematopoietic stem cells transplantation unit. Texto Contexto Enferm. 2014;23(4):845-53.⁾ Cruz et al.,⁽¹⁰10. Cruz FB, Ikeda AL, Rosa LM, Radunz V, Anders JC. Padronização dos procedimentos de enfermagem na infusão autogênica de células-tronco hematopoiéticas. Rev Enferm UERJ. 2017;25(0):e8057.⁾ Figueiredo et al.⁽¹¹11. Figueiredo TW, Mercês NN, Silva LA, Machado CA. Protocolo de cuidados de enfermagem no dia zero do transplante de células-tronco hematopoéticas: construção coletiva. Texto Contexto Enferm. 2019;28:e20180010.⁾ and Rodrigues et al.⁽¹²12. Rodrigues JA, Lacerda MR, Gomes IM, Paes MR, Ribeiro RP, Mercês NN. Research contributions for the Nursing care in pediatric transplantation of hematopoietic stem cells. Rev Pesqui Cuid Fundam Online. 2018;10(4):964-70.⁾
Thawing of hematopoietic stem cells Use sterile distilled water in the water bath to thaw the hematopoietic stem cells Keep the water bath temperature at 37ºC Maximum thawing time of 5 minutes Clean the bag connections with 70% alcohol, with thorough rubbing and at least three rotational movements	Cruz et al.⁽¹⁰10. Cruz FB, Ikeda AL, Rosa LM, Radunz V, Anders JC. Padronização dos procedimentos de enfermagem na infusão autogênica de células-tronco hematopoiéticas. Rev Enferm UERJ. 2017;25(0):e8057.⁾
During the hematopoietic stem cell infusion Placing an emergency cart near the patient's bed Administer antihistamines, antiemetics, corticosteroids, antipyretics and diuretics 30 minutes before infusion Dress up with apron, mask and cap Wear sterile gloves Place the fenestrated sterile drape under the route to be used Check ABO compatibility of hematopoietic stem cells and receiver Flush with saline solution before and after the infusion Infuse hematopoietic stem cells using equipment for blood components, without leukoreduction filter Infuse in exclusive catheter route Infuse with maximum time of 10 minutes for each bag Monitor vital signs during infusion Clean connections with 70% alcohol Watch out for signs of hypersensitivity to dimethylsulfoxide (tremors, cough, chills, fever, vomiting, dyspnea and edema of the glottis) Homogenize the bag with hematopoietic stem cells Monitor urine volume and appearance	Cruz et al.,⁽¹⁰10. Cruz FB, Ikeda AL, Rosa LM, Radunz V, Anders JC. Padronização dos procedimentos de enfermagem na infusão autogênica de células-tronco hematopoiéticas. Rev Enferm UERJ. 2017;25(0):e8057.⁾ Figueiredo et al.⁽¹¹11. Figueiredo TW, Mercês NN, Silva LA, Machado CA. Protocolo de cuidados de enfermagem no dia zero do transplante de células-tronco hematopoéticas: construção coletiva. Texto Contexto Enferm. 2019;28:e20180010.⁾ and Tormey et al.⁽¹³13. Tormey CA, Snyder EL. Hematopoietic progenitor cell administration. In: Wingard JR, Gastineau DA, Leather HL, Snyder EL, Szczepiorkowski ZM, editors. Hematopoietic stem cell transplantation: a handbook for clinicians. Bethesda: American Association of Blood Banks; 2015. p. 191-9.⁾
Nursing Process Perform the process (interview, physical examination, nursing diagnosis, nursing prescription, care check and registration) Evaluate since pre-transplantation stage Develop customized care plans	Lima et al.,⁽⁹9. Lima K, Bernardino E. Nursing care in a hematopoietic stem cells transplantation unit. Texto Contexto Enferm. 2014;23(4):845-53.⁾ Rodrigues et al.,⁽¹²12. Rodrigues JA, Lacerda MR, Gomes IM, Paes MR, Ribeiro RP, Mercês NN. Research contributions for the Nursing care in pediatric transplantation of hematopoietic stem cells. Rev Pesqui Cuid Fundam Online. 2018;10(4):964-70.⁾ Young et al.⁽¹⁴14. Young LK, Mansfield B, Mandoza J. Nursing care of adult hematopoietic stem cell transplant patients and families in the intensive care unit: an evidence-based review. Crit Care Nurs Clin North Am. 2017;29(3):341-52.⁾ and Castro et al.⁽¹⁵15. Castro EA, Andrade AM, Santos KB, Soares TC, Esterci LT. Self-care after autologous bone marrow transplantation within the nursing care process. Rev RENE. 2012;13(5):1152-62.⁾
Specialized care Central venous catheter (Hickman catheter) Standardize care related to catheter insertion, manipulation and maintenance Change the dressing and fix the catheter Maintain catheter patency (heparinized saline solution) Measure catheter length Train catheter handling routinely Prevent thrombotic obstruction of the central venous catheter	Lima et al.,⁽⁹9. Lima K, Bernardino E. Nursing care in a hematopoietic stem cells transplantation unit. Texto Contexto Enferm. 2014;23(4):845-53.⁾ Cruz et al.,⁽¹⁰10. Cruz FB, Ikeda AL, Rosa LM, Radunz V, Anders JC. Padronização dos procedimentos de enfermagem na infusão autogênica de células-tronco hematopoiéticas. Rev Enferm UERJ. 2017;25(0):e8057.⁾ Young et al.,⁽¹⁴14. Young LK, Mansfield B, Mandoza J. Nursing care of adult hematopoietic stem cell transplant patients and families in the intensive care unit: an evidence-based review. Crit Care Nurs Clin North Am. 2017;29(3):341-52.⁾ Castanho et al.,⁽¹⁶16. Castanho LC, Silveira RC, Braga FT, Canini SR, Reis PE, Voltarelli JC. Motivo de retirada do cateter de Hickman em pacientes submetidos ao transplante de células-tronco hematopoiéticas. Acta Paul Enferm. 2011;24(2):244-8.⁾ Pontes et al.⁽¹⁷17. Pontes L, Silva SR, Lima AP, Sandri LC, Batistela AP, Danski MT. Incidentes relacionados ao cateter de Hickman®: identificação de dano. Rev Bras Enferm. 2018;71(4):1915-20.⁾ and Pereira et al.⁽¹⁸18. Pereira JZ, Braga FT, Garbin LM, Castanho LC, Silveira RC. Permanence of Hickman Catheter in patients undergoing allogeneic hematopoietic stem cell transplantation: retrospective study. Rev Bras Cancerol. 2013;59(4):539-46.⁾ and Gavin et al.⁽¹⁹19. Gavin NC, Webster J, Chan RJ, Rickard CM. Frequency of dressing changes for central venous access devices on catheter-related infections. Cochrane Database Syst Rev. 2016;2:CD009213.⁾ and Rodrigues et al.⁽²⁰20. Rodrigues HF, Garbin LM, Castanho LE, Simões BP, Curcioli AC, Silveira RC. Hickman catheters in hematopoietic stem cell transplantation: surgical implantation, removal and nursing care. Rev Enferm UERJ. 2015;23(3):304-9.⁾
Infection prevention (protective isolation) Guarantee the use of facial mask, room with HEPA filter and room cleaning routine Hand hygiene before and after entering the patient's room	Lima et al.,⁽⁹9. Lima K, Bernardino E. Nursing care in a hematopoietic stem cells transplantation unit. Texto Contexto Enferm. 2014;23(4):845-53.⁾ Rodrigues et al.,⁽¹²12. Rodrigues JA, Lacerda MR, Gomes IM, Paes MR, Ribeiro RP, Mercês NN. Research contributions for the Nursing care in pediatric transplantation of hematopoietic stem cells. Rev Pesqui Cuid Fundam Online. 2018;10(4):964-70.⁾ Biagioli et al.⁽²¹21. Biagioli V, Piredda M, Annibali O, Tirindelli MC, Pignatelli A, Marchesi F, et al. Development and initial validation of a questionnaire to assess patients' perception of protective isolation following haematopoietic stem cell transplantation. Eur J Cancer Care (Engl). 2019;28(2):e12955.⁾ and Vokurka et al.⁽²²22. Vokurka S, Bystrická E, Svoboda T, Škoda Gorican IK, Sever M, Mazur E, et al. The availability of HEPA-filtered rooms and the incidence of pneumonia in patients after haematopoietic stem cell transplantation (HSCT): results from a prospective, multicentre, eastern European study. J Clin Nurs. 2014;23(11-12):1648-52.⁾
Mucositis Use standard oral cavity care protocol Clean teeth using soft brush Control pain by administering analgesics Monitoring of nutritional status	Rodrigues et al.⁽¹²12. Rodrigues JA, Lacerda MR, Gomes IM, Paes MR, Ribeiro RP, Mercês NN. Research contributions for the Nursing care in pediatric transplantation of hematopoietic stem cells. Rev Pesqui Cuid Fundam Online. 2018;10(4):964-70.⁾ and Siefker et al.⁽²³23. Siefker S, Vogelsang N. Nursing interventions for the patient experiencing mucositis. Biol Blood Marrow Transplant. 2018;24(3):S111-2.⁾
GVHD Know criteria for the evaluation of acute and chronic GVHD Assess the skin for rash, texture, joint mobility Inform the patient about skin care Know the side effects of treatment due to steroid use (infection, microvascular damage, renal dysfunction and steroid myopathy) Gastrointestinal GVHD	Santos et al.⁽²⁴24. Santos BN, Oliveira MC, Braga FT, Margatho AS, Esparrachiari LC, Silveira RC. Local cutaneous effects associated with chlorhexidine-impregnated gel dressing in hematopoietic stem cell transplantation patients. Open J Nurs. 2018;8(2):115-29.⁾ and Neumann et al.⁽²⁵25. Neumann J. Nursing challenges caring for bone marrow transplantation patients with graft versus host disease. Hematol Oncol Stem Cell Ther. 2017;10(4):192-4.⁾
Patient and family education Self-care instructions at hospital discharge	Lima et al.,⁽⁹9. Lima K, Bernardino E. Nursing care in a hematopoietic stem cells transplantation unit. Texto Contexto Enferm. 2014;23(4):845-53.⁾ Cruz et al.,⁽¹⁰10. Cruz FB, Ikeda AL, Rosa LM, Radunz V, Anders JC. Padronização dos procedimentos de enfermagem na infusão autogênica de células-tronco hematopoiéticas. Rev Enferm UERJ. 2017;25(0):e8057.⁾ Rodrigues et al.,⁽¹²12. Rodrigues JA, Lacerda MR, Gomes IM, Paes MR, Ribeiro RP, Mercês NN. Research contributions for the Nursing care in pediatric transplantation of hematopoietic stem cells. Rev Pesqui Cuid Fundam Online. 2018;10(4):964-70.⁾ Young et al.,⁽¹⁴14. Young LK, Mansfield B, Mandoza J. Nursing care of adult hematopoietic stem cell transplant patients and families in the intensive care unit: an evidence-based review. Crit Care Nurs Clin North Am. 2017;29(3):341-52.⁾ Castro et al.⁽¹⁵15. Castro EA, Andrade AM, Santos KB, Soares TC, Esterci LT. Self-care after autologous bone marrow transplantation within the nursing care process. Rev RENE. 2012;13(5):1152-62.⁾ Mazza et al.⁽²⁶26. Mazza VA, Souza C, Estevão AR, Guimarães SL, Mercês NN. Vivência de famílias de crianças e adolescentes submetidos ao transplante de células-tronco hematopoéticas. Rev Eletr Enf. 2016;18:e1193.⁾
Intravenous therapy care (preparing medications in laminar flow cabinet)	Lima et al.,⁽⁹9. Lima K, Bernardino E. Nursing care in a hematopoietic stem cells transplantation unit. Texto Contexto Enferm. 2014;23(4):845-53.⁾ Cruz et al.⁽¹⁰10. Cruz FB, Ikeda AL, Rosa LM, Radunz V, Anders JC. Padronização dos procedimentos de enfermagem na infusão autogênica de células-tronco hematopoiéticas. Rev Enferm UERJ. 2017;25(0):e8057.⁾

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[1] Corresponding author Marina Izu, E-mail: mizu@inca.gov.br