Depending on the type of cancer your child has and the treatment protocol that your child is on, there may be a significant amount of treatment given at home. This can be difficult for mums and dads to adjust to. The staff on St John’s ward will train you to give the medications or injections that may be required. There will also be training to deal with the feeding tubes and Broviac (Hickman) line, if your child has these. Staff will ensure that you are comfortable with these procedures so don’t be afraid to ask questions or to express your fears. The staff are there to help you and your child through this difficult time.
This is also known as a Broviac line and is called ‘Freddie’ in St John’s ward in Crumlin. It is a central venous catheter that allows easy access to veins in the long term. Most children diagnosed with cancer will have a ‘Freddie’ inserted prior to treatment. This makes it much simpler to administer chemotherapy blood transfusions and other IV infusions to your child. It also reduces the discomfort of blood tests.
Inserting the Hickman line is a surgical procedure done under anaesthetic. It involves two incisions, one at the jugular vein and one on the chest wall. The line is secured by means of a "cuff" just under the skin at the exit site, and the lumens (the ends of the line used for administering drugs and taking bloods, there will usually be two or three lumens) are held down otherwise by a sterile gauze or dressing centred on the exit site. This dressing also keeps the exit site clean and serves as a barrier to infection.
Children going through chemotherapy are susceptible to infection. The risk increases with the use of a ‘Freddie’. It is important to keep the ‘Freddie’ clean and dry and to flush it weekly with heparin. This will be done initially in the hospital and the nurses will explain the care of the ‘Freddie’. They will also provide spare dressings and ‘Freddie bags’ which will make it easier for your child to keep ‘Freddie’ safe while moving around. Babies wear specially designed vests with an internal pocket to keep ‘Freddie’ in.
Chemotherapy causes damage to stem cells which reduces the body’s ability to make neutrophils. When your child’s blood is low in neutrophils they are ‘neutropenic’. Severe neutropenia places your child at high risk of serious infection. Any count below 2 (2000/mm3) is considered neutropenic. The most severe neutropenia is below .5 (500/mm3) and the least severe between 1.5 and 2 (1500/mm3 and 2000/mm3).
In order to anticipate a problem it is important to take your child’s temperature frequently when they are neutropenic. If the temperature is above 38 twice in 24 hours, or 38.5 at any point, you should call St John’s ward immediately with a view to bringing your child in. If you are living outside the Dublin area you should bring your child to the local shared care hospital. Do not go through the emergency room as you may expose your child to infection. You may also have been provided with special face masks for your child to wear when entering and exiting the main areas of the hospitals. It is a good idea to keep some handy in the car. It is also advisable to keep all the relevant hospital telephone numbers (and direct dial numbers) written down in your treatment diary and also keyed into your phone if needed in a hurry.
If your child is neutropenic and has a temperature they will be admitted to hospital, blood cultures will be taken and they will be put on IV antibiotics. Their temperature will be monitored. Sometimes they may be allowed home again within a few days or they may need to stay longer. It is important that your child receives antibiotics as soon as possible as this will help prevent an infection from taking hold.
Depending on the type of cancer and stage of treatment you may be advised that your child avoids certain places or venues. This is to avoid the risk of infection and such places may include proximity to building sites, soft play areas and large crowds.
Children with cancer usually need blood transfusions. This may be due to the cancer itself or to the treatment.
Blood cells are made in the bone marrow, the spongy centre of certain bones. Cancers that start in the bone marrow (such as leukaemia) or cancers that spread there from other places may crowd out normal blood-making cells, leading to low blood counts.
Surgery to treat cancer may lead to blood loss and a need for red blood cell or platelet transfusions. Most chemotherapy drugs damage cells in the bone marrow.
This usually leads to low blood cell counts, and can sometimes put a child at risk for infections or bleeding.
When radiation is used to treat a large area of the bones, it can affect the bone marrow and lead to low blood cell counts.
Children treated with bone marrow transplant (BMT) or peripheral blood stem cell transplant (PBSCT) receive large doses of chemotherapy and/or radiation therapy. This destroys the blood-making cells in the bone marrow. They often have very low blood cell counts after the procedure and need transfusions.
Blood transfusions may be of platelets or haemoglobin, your child will receive this through the Hickman Line (Freddie). Blood transfusions are relatively painless and your child will feel better after the transfusion.