Faster platelet infusion lets children with cancer spend less time tethered to IV pole
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Children with cancer face many obstacles that prevent them from having normal childhoods.
Between chemotherapy treatments and transfusions of blood and platelets, these children can spend entire days tethered to an IV pole, which hinders their quality of life.
Although national guidelines suggest a wide range of platelet administration schedules —from 30 minutes to 4 hours — no research has analyzed the safety and efficacy of the 30-minute infusion in children with cancer.
To address this knowledge gap, researchers at University of Virginia Health conducted a study to determine whether speeding up platelet administration might free these children from IV poles sooner.
The researchers enrolled 11 inpatients, aged 3 to 17 years, undergoing cancer treatment at UVA Children’s. One group of children received platelets administered over 30 to 45 minutes, and the other group underwent a more typical transfusion lasing 2 to 4 hours.
No children experienced adverse events, and all achieved the desired platelet count targets.
“The patients in this study were children with hematology/oncology conditions,” Beth Quatrara, DNP, RN, CMSRN, ACNS-BC, nursing professor at University of Virginia, said in an interview with Healio. “They are accustomed to treatments and IVs. Providing them with time to ‘be free’ and ‘be kids’ was seen as a gift.”
Susan Steck, BSN, RN, CPN, CPHON, a pediatric nurse at University of Virginia, also participated in the pilot study. She said shortening platelet administration time for these children was one of the most rewarding parts of the study.
“The patients like the transfusions going more quickly with the chance of being disconnected from the IV pole early,” Steck told Healio. “I even had a patient discharged from the hospital earlier because his transfusion finished faster. And nurses appreciate having the IV free for other treatments earlier, if necessary, leading to more organized and timely care.”
Quatrara spoke with Healio about the results of the study, as well as her hopes for reducing IV pole time for many more children with cancer.
Question: What prompted you to take a closer look at variations in platelet infusion time?
Answer: The practice within the inpatient setting was to administer platelets over 2 to 4 hours to avoid complications. However, nurses heard about shorter infusion times from other nurses who worked in different settings and from patients who had different experiences with platelet infusions. When we questioned this practice, we looked at the science — at the guidelines — and noted the wide range. We were surprised and decided to study it.
Q: What did you find?
A: First and foremost, patients and families appreciated the 30- to 45-minute infusion time. They had more “free” time. Second, the more rapid infusion was associated with a more rapid rise in platelet goals. All patients reached the targeted platelet goal and achieved it more quickly without any adverse events. We saw that as a win-win and found no added benefit to the 2- to 4-hour infusion.
Q: Was the quickly achieved increase in platelets sustained for as long as in the group with the longer administration time?
A: We evaluated platelet levels at 30 minutes post-transfusion and noted no statistically significant differences between the groups at that time. Additional studies are needed to assess the sustainability of the platelet level increase over time.
Q: How did the children react?
A: As we enrolled patients and randomly assigned them to the "super-fast" group, you could see their faces light up — and those of their families, too. I recall consenting a patient/family who needed the platelet infusion prior to discharge. When the patient was assigned to the 30- to 45-minute group, excitement filled the room — it was as if we were having a party.
Q: What is next in terms of further research?
A: We plan to replicate the pilot study on a larger scale.
For more information:
Beth Quatrara, DNP, RN, CMSRN, ACNS-BC, can be reached at 224 Jeannette Lancaster Way, Charlottesville, VA 22903-3385; email: bad3@virginia.edu.
Susan Steck, BSN, RN, CPN, CPHON, can be reached at 1214 Lee St., 7 West, Charlottesville, VA 2290; email: ses7e@hscmail.mcc.virginia.edu.
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