Supportive care: managing febrile neutropenia

Chemotherapy, the most commonly used treatment for childhood cancer, can have a devastating effect on the immune system, reducing defences against infection, particularly bacterial infection, a common cause of life-threatening sepsis. Before they leave hospital for the first time after diagnosis, patients and carers need to understand what neutropenia is and how to monitor for and recognise signs and symptoms of infection. This article describes the approach to the nursing aspects of managing febrile neutropenia at Birmingham Children's Hospital NHS Foundation Trust. Approaches to avoiding infection at home include good hand hygiene and careful management of food, drink and the child's environment. There needs to be a balance between avoiding infection risks and allowing the child to maintain a normal social life, including attending school. Preventing infection in hospital requires similar measures to those required to prevent infection in any patient. Careful monitoring of the neutropenic child is necessary so that infection is recognised early and treatment initiated rapidly. National, evidence-based guidelines for the prevention and management of febrile neutropenia should be followed, particularly the open access policy enabling patients/carers to call for advice 24 hours a day.