Upon admission to the stem cell transplant unit, a countdown period of usually five to 10 days begins. Day 0 marks the end of the countdown, which is the day of transplant. During the countdown period, the conditioning regimen is administered. This includes treatment with chemotherapy and/or radiation. Following transplant, the days are counted up (first day after transplant is Day + 1).
The stem cell transplant inpatient unit is a special unit with a HEPA-filtering system which filters out germs in the air. Due to this filtering system, the children are allowed to go outside their rooms to exercise, socialize or participate in activities in the playroom but may not go outside the unit. Parents and visitors must understand that if they have or may have an infection, they risk spreading the infection to their child and other patients. For your child’s safety and the safety of other patients, please observe these guidelines.
There are exceptions to this rule, if the patient needs any tests or procedures they will be allowed to go off the floor but they must wear their hepa-filtered mask. If any time during the admission the patient acquires an infection and gets placed on isolation, they must remain in their room. Isolation procedures are designed to prevent the spread of a confirmed or suspected infectious contagious disease from one individual to another.
Parents may stay in the patient room which has a day bed, television, DVD player, phone, sink and private bathroom with a shower and bath. Each room is also equipped with a scale, so that there will be no cross contamination for the patients for their daily weight and also to ensure accuracy of the reading. The room is cleaned every day and everyone who enters the room must follow specific procedures to minimize complications associated with the transplant process.
Hand washing is the best way to prevent infections. All patients and visitors must wash their hands before entering the stem cell transplant unit and again before entering the patient’s room. Any time you exit the patient’s room, you must rewash your hands before entering the patient’s room. In addition, a person must re-wash their hands after using the bathroom, assisting the patient in the bathroom or preparing food.
Establishing a daily routine
We understand that the transplant process is a difficult one. However, we need your cooperation with the unit guidelines below to aid your child’s recovery. These guidelines were developed to optimize your child’s health, to decrease the risk of infection and maintain a normal daily routine as much as possible.
There are several routines that are done daily or several times a day to minimize those problems that may occur during the stem cell transplant process.
- Bathing. Daily bathing with a special soap (Chlorhexidine) will keep the skin germ free.
- Mouth Care. Mouth sores are a side effect of chemotherapy and radiation. Brushing the teeth and tongue with a soft toothbrush as well as using mouthwashes are 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.
- Vital signs. Vital signs are taken around the clock every four hours starting at 8:00am. Temperature, blood pressure, heart rate, respirations will be monitored every 4 hours during your transplant hospitalization. It is necessary to monitor these readings very closely. All patients are weighed daily before morning rounds at 10am. Fluid shifts in the body make it important to monitor weights closely.
- School age children should continue their lessons by daily interaction with one of the school teachers from HISD.
- All visitors must check-in at the reception area in the clinic or the nurse’s station on the inpatient unit. A member of the staff will check if the patient is ready for visitors.
- Parents and legal guardians may visit at any time.
- Only two visitors, including parents, will be allowed in the patient’s room. Effective patient care and cleanliness are compromised when patient rooms become crowded. Any remaining visitors must wait in the West Tower lobby on the first floor.
- Only 1 person over the age of 18 may stay overnight with the child. It is important that the patient is able to get adequate rest overnight.
- Although there is no age limit for visitors to the SCT unit, young children present a greater risk of carrying a contagious disease. It is the parents’ responsibility to screen young siblings or other children visiting the patient.
- Siblings and young children are never allowed in any area of the SCT unit except the patient’s room. Supervision of child visitors is the responsibility of the parents.
- Visitors with any signs and symptoms of contagious diseases or infections are not permitted to enter the SCT unit. Signs and symptoms of contagious diseases or infections may include fever, runny nose, sore throat, eye discharge, pink eye, cold or flu-like symptoms, vomiting, diarrhea, cough, skin rash or recent exposure to a contagious disease.
- To provide protection from infectious diseases, patients’ visiting between inpatient rooms or the clinic is not permitted.
Remember, the transplant process will span several weeks. Therefore, it is as important for the family as it is for the patient to get proper rest. For this reason it is often best for the parents or caregivers to alternate their schedules.
The SCT playroom is located on the unit and remains open 24 hours. There are a variety of toys, games, activities, puzzles and crafts for children of all ages. All families are encouraged to use the playroom for any activities they feel their child will enjoy and may bring activities back to their child’s room if desired. The following are a few rules to make the playroom an enjoyable place for all children:
- Every child under the age of 12 must be accompanied by an adult while in the playroom.
- No siblings are allowed in the playroom.
- No eating, drinking or medical procedures are allowed in the playroom.
- Everyone must clean up their activities before returning to their room. This is to keep our playroom a clean and safe environment.
- Any patient who is on isolation is not allowed in the playroom.
- Dirty toys can be placed in the dirty toy bin to be cleaned by the hospital staff.
Let this room stimulate all of your senses. Watch the bubble tube change colors. Let the fiber optic waterfall surround you and take you away from all the chaos around you. Sights, sounds and sensations can help stimulate or relax your senses. Aromatherapy can be turned on to fill the room with your favorite scents. Dim the lights and watch a DVD movie. Have fun with the Wii system available here. Feel free to bring exercise videos to help with relaxation and normalcy.
- Children need to be attended by a parent at all times.
- Food and drink are not allowed.
- Siblings of patients may borrow items from the multisensory room and playroom, but are not allowed to play in either.
What to Pack
Planning for a stay in the hospital is never an easy task. It is even harder to try to plan for the extended stay during your child’s transplant. Involve your child in the planning and preparation for the transplant period. Bring personal items to decorate your child’s room to make it feel more like their room at home. Include any comfort or familiar items your child may have to promote a positive transition into the hospital. Posters or Mylar balloons will brighten up the room. Plants and fresh flowers are not permitted in the SCT clinic or inpatient unit because the soil and water may carry bacteria and fungus, which may make your child ill.
- Clothes: Bring your child’s favorite pajamas, t-shirts or night shirts. Laundry facilities are located within the hospital. Patient gowns can be provided if your child prefers them.
- Linen: You may bring special or favorite blankets, pillows or comforters; however if these become soiled, your child will have to use hospital linen until you can wash them. All items must be freshly laundered prior to admission to the hospital.
- Toys: Toys, games, puzzles and dolls are welcome in the BMT unit. Please bring books and activities to entertain your child. Older children can help by making a list of things they want to bring with them. Every room in the unit is equipped with a TV and VCR. There are some movies available on the unit but you are welcome to bring home videos or favorite movies. Be sure to label all possessions with your name.
Special Considerations for Different Ages
Infants and toddlers may not be able to tell you what they want, but you know their favorites. Bring several toys and dolls that they play with repeatedly. Because this age group has a very short attention span, you will need to pack a variety of items. Movies and music are also good entertainment.
Preschoolers should be able to play by themselves for short periods of time. Favorite things from home such as dolls, blocks, cars and puzzles can encourage independent activity and self reliance. You should also bring things to do together such as simple games or books to read.
School-aged children can help to plan ahead and make a list of things they want to do during their hospital stay. Starting simple craft projects that have several steps are good for this age group. Choosing projects that are too difficult are often discouraging. Your school age child may benefit by being included in the packing process. This will allow them to feel more prepared for the hospital.
Teenagers should take responsibility for planning what they want to have available to them to do during their extended hospital stay. Because they will want to keep in touch with their friends, they will want to make sure they have friends’ phone numbers and addresses with them. Craft projects, video games, books and music are things that they will enjoy having available.
When you are first admitted, bring the most necessary items: clothes, toiletries, and a few toys. As your stay continues, you can bring additional things from home. Bring pictures of family members and other important people in your child’s life. Photos help to remind you and your child that there is life outside the hospital. You can also plan on switching things out from home. Posters and wall décor, or favorite bed sheets and blankets also make each patient feel more at home in their room. Each time you bring something back; there is a newness to it, which encourages play. Use and borrow as much as you can from the playroom. The Child Life Specialist keeps a wide variety of toys and art projects for all age groups.
Self-serve washers and dryers are located on the family services floor, on the 16th floor of the West Tower. They are available at no charge; however, detergent and fabric softener are not provided by the hospital and must be obtained by each individual family. Any type of detergent may be used for your child’s clothes.
Meals for Parents
Trays from the cafeteria may be provided for parents upon request; however you will be charged for the additional tray. Complimentary coffee and pastries are available in the inpatient unit and clinic daily for breakfast. There is a full size refrigerator located on the transplant unit for you to bring food from home if you desire. If you keep food in this refrigerator, please label the contents with your name and date. There also is a microwave oven located on the transplant unit for your use. Please do not leave any opened food in the patient’s room for longer than one hour. There are also a variety of places to eat around the medical center including a food court, snack carts and nearby restaurants.
Parking facilities are operated by the Texas Medical Center Parking Services. Daily rates (24 hours) and monthly contract passes are available in the gift shops. Contact the TMC parking office at (713) 791-6161 for more information. If funding for parking is an issue, please contact your social worker.