Admission to the Pediatric Bone Marrow Transplant Unit

Upon admission to the Bone Marrow Transplant Unit, a countdown period of usually five to 10 days begins. Day 0 marks the end of the countdown and the day of transplant. During the countdown period, one of the conditioning regimens is administered. This involves treatment with chemotherapy agents and possibly radiation, called total body irradiation.

The BMT Room

Patients stay in a special BMT room with a bed, television, VCR, phone, sink and private bathroom with a shower and bath. It is a special room that provides a positive pressure environment in which only highly purified (HEPA-filtered) air is allowed to enter. The room is cleaned every day, and everyone who enters the room must follow specific procedures to minimize complications associated with the transplant process. Visitors to the BMT Unit must follow certain rules that protect the transplant recipient and help our program run smoothly.

All visitors — including doctors, nurses, other members of the health care team and family members — must wash their hands before entering and leaving the room. In addition, there is a clean outer room, called an anteroom, that separates the patient's room from the hallway. The doors to the anteroom and patient room are kept closed at all times thus maintaining the positive pressure environment. This isolation policy is intended to minimize the risk of developing an infection during the transplant process. Transplant patients must stay in their room, except for when they need radiation therapy or occasional tests or procedures that can only be done elsewhere, until the new marrow has begun to work. The total amount of time in the Transplant Unit varies, but generally it is six to eight weeks.

Daily Care

There are several routines that are done daily or several times a day to minimize those problems that may occur during the bone marrow transplant process.

• Bathing — Bathing with a special soap (HibiclensR, comfort wipes or Neutrogena), mineral oil and sterile water to keep the skin germ free. This happens daily.
• Mouth Care — Mouth sores are a side effect of chemotherapy and radiation. Brushing the teeth and tongue as well as using mouthwashes is essential to keep the mouth as clean as possible. This happens four times a day. Good mouth care can greatly reduce the severity of mouth sores.
• Catheter Care — Specific procedures and dressing changes will be followed to keep the catheter exit site clean.
• Ointments — Sterile water and disinfectant soap will be used after every bowel movement to help prevent the skin on the buttocks from becoming irritated. Application of some ointment to the area will help provide a protective barrier. This will be extremely important to do especially when diarrhea occurs, a common side effect of many drugs used during the transplant.

Oral and Intravenous Medications

Antibiotics and medicines are given throughout the transplant period to reduce irritation of the stomach and intestines and prevent certain kinds of infections that frequently occur in a transplant recipient. These medications are continued until isolation is stopped, although some may be discontinued if your child is started on intravenous antibiotics because of fever or other signs of infection during the isolation period — while the neutrophil count (ANC) is less than 500. The daily medications include:

• Septra/Bactrim — An antibiotic for prevention of lung infection and infections originating in the intestines. It is given twice daily on Friday, Saturday and Sunday beginning two weeks after transplant once the ANC is greater than 500 for three consecutive days.
• Fluconozole — An antibiotic that reduces the risk of some fungal infections.
• Acyclovir — An anti-viral drug for prevention of herpes infections. When the patient is preparing to go home this medicine is switched from an IV to an oral preparation if prophylaxis is indicated.
• Gammaglobulin — An intravenous medication that provides additional antibodies in the blood to help ward off infections. In the hospital the patient will receive a dose every two weeks. After discharge the patient will receive gammaglobulin every four weeks until his or her ability to fight infection returns to normal.
• Sodium bicarbonate — An oral mouth wash that helps reduce the development of mouth sores and infection.
• Sodium fluoride — An oral supplement to help maintain healthy teeth.