Nursing Considerations

  • Brienne LearyEmail author
  • Barbara Cuccovia
  • Colleen Nixon


Care of the critically ill pediatric hematology/oncology/hematopoietic cell transplantation (HCT) patient in the pediatric intensive care unit (PICU) is complex and challenging. This patient population requires significant resource utilization, exceptional nursing and physician expertise, and high-level care coordination. Nevertheless, they represent a disproportionately low number of all PICU admissions, rendering them a high acuity-low frequency patient population. Historically, outcomes for critically ill pediatric hematology/oncology/HCT patients have been poor. Current data suggests marked improvements in short- and long-term survival, thanks to novel treatment regimens and advances in supportive and critical care.

In both the inpatient pediatric hematology/oncology/HCT unit(s) and the PICU, nurses at the bedside and in advanced practice roles are integral members of the care team contributing to this trend. Achieving family-centered care and optimal patient outcomes requires collaboration, communication, and respect of each other’s specialties. A strong interdisciplinary care model that builds operational partnerships while considering institutional variation is essential.

This chapter will focus on describing the multifaceted needs of clinical situations the critically ill hematology/oncology/HCT patient may experience. The challenges of chemotherapy and biotherapy administration in the PICU will also be addressed. Strategies to combat compassion fatigue and staff distress are also explored.


Pediatric intensive care Nursing Interdisciplinary Multidisciplinary Collaboration Complexity System(s) Acuity Patient- and family-centered care (PFCC) Chemotherapy biotherapy Oncology Hematology Hematopoietic cell transplant(ation) Complications 



We are grateful to the following individuals for the insight, guidance, and knowledge they shared with us throughout the development of this chapter: Robyn Blacken, Peggy Brill-Conway, Celeste Chandonnet, Janet Duncan, Colleen Gerrity, Steven Sloan, and Lindsay Weir.


  1. 1.
    Kendall S. Witnessing tragedy: nurses’ perceptions of caring for patients with cancer. Int J Nurs Pract. 2007;13(2):111–20. Scholar
  2. 2.
    Howlader N, Noone AM, Krapcho M, Miller D, Bishop K, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA, editors. SEER cancer statistics review, 1975–2014. Bethesda, MD: National Cancer Institute., based on November 2016 SEER data submission, posted to the SEER web site, April 2017
  3. 3.
    National Cancer Institute. Cancer in children and adolescents. In: Childhood cancers. 2017.
  4. 4.
    Rosenman MB, Vik T, Hui SL, Breitfeld PP. Hospital resource utilization in childhood cancer. J Pediatr Hematol Oncol. 2005;27(6):295–300.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Dalton HJ, Slonim AD, Pollack MM. Multicenter outcome of pediatric oncology patients requiring intensive care. Pediatr Hematol Oncol. 2003;20:643–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Dursun O, Hazar V, Karasu GT, Uygun V, Tosun O, Yesilipek A. Prognostic factors in pediatric cancer patients admitted to the pediatric intensive care unit. J Pediatr Hematol Oncol. 2009;31:481–4.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Heying R, Schneider DT, Körholz D, Stannigel H, Lemburg P, Göbel U. Efficacy and outcome of intensive care in pediatric oncologic patients. Crit Care Med. 2001;29(12):2276–80. Scholar
  8. 8.
    Maude S, Fitzgerald J, Fisher B, Li Y, Huang YS, Aplenc R, et al. Outcome of pediatric acute myeloid leukemia patients receiving intensive care in the United States. Pediatr Crit Care Med. 2014;15:112–20. Scholar
  9. 9.
    Balit CR, Horan R, Dorofaeff T, Frndova H, Doyle J, Cox PN. Pediatric hematopoietic stem cell transplant and intensive care: have things changed? Pediatr Crit Care Med. 2016;17(3):e109–16. Scholar
  10. 10.
    Chima RS, Daniels RC, Kim M, Li D, Wheeler DS, Davies SM, Jodele S. Improved outcomes for stem cell transplant recipients requiring pediatric intensive care. Pediatr Crit Care Med. 2012;12(6):e336–42. Scholar
  11. 11.
    Hallahan AR, Shaw PJ, Rowell G, et al. Improved outcomes of children with malignancy admitted to a pediatric intensive care unit. Crit Care Med. 2000;28(11):3718–21. Scholar
  12. 12.
    Duncan CN, Lehmann L, Cheifetz IM, Greathouse K, Haight AE, Hall MW, McArthur J, et al. Clinical outcomes of children receiving intensive cardiopulmonary support during hematopoietic stem cell transplant. Pediatr Crit Care Med. 2013;14(3):261–7. Scholar
  13. 13.
    Herring RA, Hesselgrave J, Norville R, Madsen LB. Toxicity and symptom management. In: Kline N, editor. The pediatric chemotherapy and biotherapy curriculum. 3rd ed. Chicago: APHON; 2011. p. 105–51.Google Scholar
  14. 14.
    Murphy G. The technology-dependent child at home part 1: in whose best interest? Paediatr Nurs. 2001;13:14–8.CrossRefGoogle Scholar
  15. 15.
    Wagner J, Power E, Fox H. Technology-dependent children: hospital versus home care. 1987. Congress of the United States: Office of Technology Assessment.Google Scholar
  16. 16.
    National Marrow Donor Program, a contractor for the C.W. Bill Young Cell Transplantation Program operated through the U.S. Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau. Growth in number of registry transplants. 2013. Accessed 18 Jan 2018.
  17. 17.
    U.S. National Library of Medicine. Mucopolysaccharidosis type I. (2012). Accessed 1 Jan 2018.
  18. 18.
    Douglas IS, Schmidt GA, Hall JB. Acute-on-chronic respiratory failure. In: Hall JB, Schmidt GA, Wood LDH, editors. Principles of critical care. 3rd ed. New York: The McGraw-Hill Companies; 2005.Google Scholar
  19. 19.
    Chima RS, Abulebda K, Jodele S. Advances in critical care of the pediatric hematopoietic stem cell transplant patient. Pediatr Clin of North Am. 2013;60(3):689–707. Scholar
  20. 20.
    Zinter MS, Dvorak CC, Spicer A, Cowan MJ, Sapru A. New insights into multicenter PICU mortality among pediatric hematopoietic stem cell transplant patients. Crit Care Med. 2015;43:1986–94. Scholar
  21. 21.
    Shannon E. How can oncology and ICU nurses work together to treat critically ill patients with cancer? ONS Voice. 2017;32(7):19.Google Scholar
  22. 22.
    Lo B, Jonsen AR. Clinical decisions to limit treatment. Ann Intern Med. 1980;93:764.PubMedCrossRefGoogle Scholar
  23. 23.
    Schuster DP, Marion JM. Precedents for meaningful recovery during treatment in a medical intensive care unit: outcome in patients with hematologic malignancy. Am J Med. 1983;75:402.PubMedCrossRefGoogle Scholar
  24. 24.
    Schapira DV, Studnicki J, Bradham DB, Wolff P, Anne JA. Intensive care, survival, and expense of treating critically ill cancer patients. JAMA. 1993;269:783–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Lloyd-Thomas ART, Dhaliwal HS, Lister TA. Intensive therapy for life-threatening complications of hematologic malignancy. Intens Care Med. 1986;12:317–24.CrossRefGoogle Scholar
  26. 26.
    Torrecilla C, Corte’s JL, Chamorro C. Prognostic assessment of the acute complications of bone marrow transplantation requiring intensive therapy. Intens Care Med. 1988;14:393–8.CrossRefGoogle Scholar
  27. 27.
    Butt W, Barker G, Walker C, et al. Outcome of children with hematologic malignancy who are admitted to an intensive care unit. Crit Care Med. 1988;16:761–4.PubMedCrossRefGoogle Scholar
  28. 28.
    DeNardo SJ, Oye RK, Bellamy PE. Efficacy of intensive care for bone marrow transplant patients with respiratory failure. Crit Care Med. 1989;17:4–6.PubMedCrossRefGoogle Scholar
  29. 29.
    Sivan Y, Schwartz PH, Schonfeld T, et al. Outcome of oncology patients in the pediatric intensive care unit. Intensive Care Med. 1991;17:11–5.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Todd K, Wiley F, Landaw E, et al. Survival outcome among 54 intubated pediatric bone marrow transplant patients. Crit Care Med. 1994;22:171–6.PubMedCrossRefGoogle Scholar
  31. 31.
    Nichols DG, Walker LK, Wingard JR, et al. Predictors of acute respiratory failure after bone marrow transplantation in children. Crit Care Med. 1994;22:1485–91.PubMedCrossRefGoogle Scholar
  32. 32.
    Adamson P. Developing drugs for pediatric malignancies. Clin Adv Hematol Oncol. 2011;11:227–9.Google Scholar
  33. 33.
    Baggot C. Neutropenia. In: Kline NE, editor. Essentials of pediatric hematology/oncology nursing: a core curriculum. 4th ed. Glenview: Association of Pediatric Hematology/Oncology Nurses; 2014. p. 95–6.Google Scholar
  34. 34.
    Tomblyn M, Chiller T, Einsele H, Gress R, Sepkowitz K, Storek J, Wingard JR, Young JH, Boeckh MA. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biol Blood Marrow Transplant. 2009;15:1143–238. Scholar
  35. 35.
    Lo E, Nicolle L, Classen D, Arias KM, Podgorny K, Anderson DJ, et al. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29(Suppl 1):S41–50. Scholar
  36. 36.
    Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA, the Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for prevention of catheter-associated urinary tract infections 2009: Centers for Disease Control; 2017.
  37. 37.
    Joint Commission. National patient safety goals effective January 1, 2013. 2012. Accessed 1 Dec 2017.
  38. 38.
    Scott DR. The direct medical costs of healthcare-associated infections in U.S. hospitals and the benefits of prevention: Centers for Disease Control; 2009.
  39. 39.
    McCoy C, Paredes M, Allen S, Blackey J, Nielsen C, Paluzzi A, Jonas B, Radovich P. Catheter-associated urinary tract infections: implementing a protocol to decrease incidence in oncology populations. Clin J Oncol Nurs. 2017;21:460–5. Scholar
  40. 40.
    Riachy E, Krauel L, Rich B, McEvoy M, Honeyman J, La Quaglia M, et al. Risk factors and predictors of severity score and complications of pediatric hemorrhagic cystitis. J Urol. 2014;191(1):186–92. Scholar
  41. 41.
    Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29(7):1303–10.PubMedCrossRefGoogle Scholar
  42. 42.
    Centers for Disease Control. Preventing infections in cancer patients. 2017. Accessed 1 Jan 2018.
  43. 43.
    Novosad SA, Sapiano MR, Grigg C, et al. Vital signs: epidemiology of sepsis: prevalence of health care factors and opportunities for prevention. MMWR Morb Mortal Wkly Rep. 2016;65:864–9. Scholar
  44. 44.
    Lindell R, Gertz S, Rowan C, McArthur J, Beske F, Fitzgerald J, et al. High levels of morbidity and mortality among pediatric hematopoietic cell transplant recipients with severe sepsis: insights from the Sepsis PRevalence, OUtcomes, and Therapies International Point Prevalence Study. Pediatr Crit Care Med. 2017;18(12):1114–25. Scholar
  45. 45.
    Singer K, Subbaiah P, Hutchinson R, Odetola F, Shanley TP. Clinical course of sepsis in children with acute leukemia admitted to the pediatric intensive care unit. Pediatr Crit Care Med. 2011;12:649–54. Scholar
  46. 46.
    Goldstein B, Giroir B, Randolph A, et al. International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005;6:2–8. Scholar
  47. 47.
    Simmons ML, Durham SH, Carter CW. Pharmacological management of pediatric patients with sepsis. AACN Adv Crit Care. 2012;23(4):437–48. Scholar
  48. 48.
    Weiss SL, Fitzgerald JC, Pappachan J, Wheeler D, Jaramillo-Bustamante JC, Salloo A, Singhi SC, Erickson S, Roy JA, Bush JL, Nadkarni VM, Thomas NJ. Sepsis Prevalence, Outcomes, and Therapies (SPROUT) study investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) network. Global epidemiology of pediatric severe sepsis: the sepsis prevalence, outcomes, and therapies study. Am J Respir Crit Care Med. 2015;191(10):1147–57.PubMedPubMedCentralCrossRefGoogle Scholar
  49. 49.
    Burke ML, Salani D. Hematologic and oncologic emergencies requiring critical care. In: Hazinski MF, editor. Nursing care of the critically ill child. 3rd ed. St. Louis: Elsevier; 2013. p. 825–50.Google Scholar
  50. 50.
    Norville R, Staton S. Hematopoietic stem cell transplantation. In: Kline N, editor. Essentials of pediatric hematology/oncology nursing: a core curriculum. 4th ed. Chicago: APHON; 2014. p. 160–80.Google Scholar
  51. 51.
    Secola R, Reid D. Oncologic emergencies. In: Kline N, editor. Essentials of pediatric hematology/oncology nursing: a core curriculum. 4th ed. Chicago: APHON; 2014. p. 252–9.Google Scholar
  52. 52.
    de Caen AR, Berg MD, Chameides L, et al. Pediatric Advanced Life Support 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency care. Pediatrics. 2015;136:S176. Scholar
  53. 53.
    Society of Critical Care Medicine. History: Surviving Sepsis Campaign. 2016.
  54. 54.
    Davis A, Carcillo J, Aneja R, Deymann A, Lin J, Zuckerberg A, et al. American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock. Crit Care Med. 2017;45(6):1061–93. Scholar
  55. 55.
    Balamuth F, Alpern E, Abbadessa M, Hayes K, Schast A, Zorc J, et al. Improving recognition of pediatric severe sepsis in the emergency department: contributions of a vital sign-based electronic alert and bedside clinician identification. Ann Emerg Med. 2017;70(6):759.e2–68.e2. Scholar
  56. 56.
    Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2011:52(4). Scholar
  57. 57.
    Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43(3):304–77. Scholar
  58. 58.
    Ventura AM, Shieh HH, Bousso A, et al. Double-blind prospective randomized controlled trial of dopamine versus epinephrine as first-line vasoactive drugs in pediatric septic shock. Crit Care Med. 2015;43:2292–302. Scholar
  59. 59.
    Louden DT, Rutman LE. Inotropic therapy for sepsis. Pediatr Emerg Care. 2018;34(2):132–5. Scholar
  60. 60.
    Tamburro RF, Barfield RC, Shaffer ML, Rajasekaran S, Woodard P, Morrison RR, et al. Changes in outcomes (1996–2004) for pediatric oncology and hematopoietic stem cell transplant patients requiring invasive mechanical ventilation. Pediatr Crit Care Med. 2008;9(3):270–7. Scholar
  61. 61.
    Curley MAQ, Thompson JE. Oxygenation and ventilation. In: Curley M, Moloney-Harmon PA, editors. Critical care nursing of infants and children. Philadelphia: W. B. Saunders Company; 2001. p. 233–308.Google Scholar
  62. 62.
    Grant MJC, Curley MAQ. Pulmonary critical care problems. In: Curley M, Moloney-Harmon PA, editors. Critical care nursing of infants and children. Philadelphia: W. B. Saunders Company; 2001. p. 655–94.Google Scholar
  63. 63.
    Cocoros NM, Kleinman K, Priebe GP, Lee G, et al. Ventilator-associated events in neonates and children – a new paradigm. Crit Care Med. 2016;44:14–22. Scholar
  64. 64.
    Klompas M, Branson R, Eichenwald E, Greene L, Howell M, Berenholtz S, et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35:915–36. Scholar
  65. 65.
    The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342:1301–8. Scholar
  66. 66.
    Pediatric Acute Lung Injury Consensus Conference. Pediatric acute respiratory distress syndrome: consensus recommendations from the. Pediatr Crit Care Med. 2015;16:428–39.
  67. 67.
    Fuchs H, Rossmann N, Schmid MB, Hoenig M, Thome U, Mayer B, et al. Permissive hypercapnia for severe acute respiratory distress syndrome in immunocompromised children: a single center experience. PLoS One. 12(6):e0179974. Scholar
  68. 68.
    Kluge S, Baumann HJ, Nierhaus A, Kröger N, Meyer A, Kreymann G. Safety of percutaneous dilational tracheostomy in hematopoietic stem cell transplantation recipients requiring long-term mechanical ventilation. J Crit Care. 2008;23:394–8. Scholar
  69. 69.
    Gordin A, Netzer A, Joachims HZ, Golz A. Percutaneous tracheotomy in bone marrow transplant patients with severe thrombocytopenia. J Otolaryngol Head Neck Surg. 2005;133:377–80. Scholar
  70. 70.
    Elbahlawan L, Rains KJ, Stokes DC. Respiratory care considerations in the childhood cancer patient. Respir Care [Internet]. 2017;62(6):765–75. Available from: Scholar
  71. 71.
    Hertzog JH, Dalton HJ, Anderson BD, Shad AT, Gootenberg JE, Hauser GJ. Prospective evaluation of propofol anesthesia in the pediatric intensive care unit for elective oncology procedures in ambulatory and hospitalized children. Pediatrics. 2000;106(4):742–7.PubMedCrossRefPubMedCentralGoogle Scholar
  72. 72.
    Holdsworth MT, Raisch DW, Winter SS, Frost JD, Moro MA, Doran NH, Phillips J, Pankey JM, Mathew P. Pain and distress from bone marrow aspirations and lumbar punctures. Ann Pharmacother. 2003;37(1):17–22.PubMedCrossRefPubMedCentralGoogle Scholar
  73. 73.
    Spagrud LJ, von Baeyer CL, Ali K, Mpofu C, Fennell LP, Friesen K, Mitchell J. Pain, distress, and adult-child interaction during venipuncture in pediatric oncology: an examination of three types of venous access. J Pain Symptom Manag. 2008 Aug;36(2):173–84. Scholar
  74. 74.
    Zernikow B, Meyerhoff U, Michel E, Wiesel T, Hasan C, Janssen G, Kuhn N, Kontny U, Fengler R, Gortitz I, Andler W. Pain in pediatric oncology – childrens’ and parents’ perspectives. Eur J Pain. 2005;9:395–406. Scholar
  75. 75.
    Oakes LL. Caring practices: providing comfort. In: Curley M, Moloney-Harmon PA, editors. Critical care nursing of infants and children. Philadelphia: W. B. Saunders Company; 2001. p. 547–76.Google Scholar
  76. 76.
    Branowicki P, Houlahan KE, Conley S, Kline NE. Nursing care of patients with childhood cancer. In: Orkin SH, Fisher DE, Ginsburg D, Look AT, Lux SE, Nathan DG, editors. Nathan and Oski’s hematology and oncology of infancy and childhood. Philadelphia: Elsevier Saunders; 2015. p. 2292–319.Google Scholar
  77. 77.
    Adlard K. Central venous access devices. In: Kline NE, editor. Essentials of pediatric hematology/oncology nursing: a core curriculum. 4th ed. Association of Pediatric Hematology/Oncology Nurses: Glenview; 2014.Google Scholar
  78. 78.
    Reigart JR, Chamberlain KH, Eldridge D, et al. Peripheral intravenous access in pediatric inpatients. Clin Pediatr. 2012;51(5):468–72. Scholar
  79. 79.
    Kuensting LL, DeBoer S, Holleran R, Shultz BL, Steinmann RA, Venella J. Difficult venous access in children: taking control. J Emerg Nurs. 2009;35:419–24. Scholar
  80. 80.
    Higgerson RA, Lawson KA, Christie LM, Brown AM, McArthur JA, Totapally BR, Hanson SJ, National Association of Children’s Hospitals and Related Institutions’ Pediatric Intensive Care Unit FOCUS group. Incidence and risk factors associated with venous thrombotic events in pediatric intensive care unit patients. Pediatr Crit Care Med. 2011;12(6):628–34. Scholar
  81. 81.
    Tullius BP, Athale U, van Ommen CH, Chan AKC, Palumbo JS, Balagtas JMS, for the Subcommittee on Hemostasis and Malignancy and the Subcommittee on Pediatric/Neonatal Thrombosis and Hemostasis. The identification of at-risk patients and prevention of venous thromboembolism in pediatric cancer: guidance from the SSC of the ISTH. J Thromb Haemost. 2018;16:175–80. Scholar
  82. 82.
    National Healthcare Safety Network (NHSN). Centers for Disease Control and Prevention. 2018. Bloodstream infection event (central lineassociated bloodstream infection and non-central line associated bloodstream infection).
  83. 83.
    Centers for Disease Control and Prevention (CDC). National and state healthcare-associated infections progress report. 2016. Available at
  84. 84.
    Gaur AH, Bundy DG, Werner EJ, Hord JD, Miller MR, Li T, Lawlor JP, Billett AL. A prospective, holistic, multicenter approach to tracking and understanding bloodstream infections in pediatric hematology-oncology patients. Infect Control Hosp Epidemiol. 2017;38(6):690–6. Scholar
  85. 85.
    Bundy DG, Gaur AH, Billett AL, He B, Colantuoni EA, Miller MR, on behalf of Children’s Hospital Association Hematology/Oncology CLABSI Collaborative. Preventing CLABSIs among pediatric hematology/oncology inpatients: national collaborative results. Pediatrics. 2014;134(6):e1678–85. Scholar
  86. 86.
    The Joint Commission. Preventing central line–associated bloodstream infections: a global challenge, a global perspective. Oak Brook: Joint Commission Resources. 2012. http://www.PreventingCLABSIs.pdf. Accessed 1 Jan 2018.
  87. 87.
    Centers for Disease Control and Prevention (CDC). Operational guidance for acute care hospitals to report central line-associated bloodstream infection (CLABSI) data to CDC’s NHSN for the purpose of fulfilling CMS’s hospital inpatient quality reporting (IQR) requirements. 2014. Available at: Accessed 14 Jan 2018.
  88. 88.
    Centers for Medicare and Medicaid Services (CMS). Hospital-acquired condition (HAC) reduction program. 2015. Accessed 15 Jan 2018.
  89. 89.
    Hanna HA, Raad I. Blood products: a significant risk factor for long-term catheter-related bloodstream infections in cancer patients. Infect Control Hosp Epidemiol. 2001;22:165–6.PubMedCrossRefPubMedCentralGoogle Scholar
  90. 90.
    Marschall J, Mermel L, Fakih M, Hadaway L, Kallen A, O’Grady N, et al. Strategies to prevent central line–associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(7):753–71. Scholar
  91. 91.
    Epstein L, See I, Edwards JR, Magill SS, Thompson ND. Mucosal barrier injury laboratory-confirmed bloodstream infections (MBI-LCBI): descriptive analysis of data reported to National Healthcare Safety Network (NHSN), 2013. Infect Control Hosp Epidemiol. 2016;37(1):2–7.PubMedCrossRefGoogle Scholar
  92. 92.
    Metzger KE, Rucker Y, Callaghan M, et al. The burden of mucosal barrier injury laboratory-confirmed bloodstream infection among hematology, oncology, and stem cell transplant patients. Infect Control Hosp Epidemiol. 2015;36:119–24. Scholar
  93. 93.
    Dandoy C, Haslam D, Davies S, et al. Healthcare burden, risk factors, and outcomes of mucosal barrier injury laboratory-confirmed bloodstream infections after stem cell transplantation. Biol Blood Marrow Transplant. 2016;22(9):1671–7. Scholar
  94. 94.
    Simon A, Furtwangler R, Graf N, et al. Surveillance of bloodstream infections in pediatric cancer centers: what have we learned and how do we move on? GMS Hyg Infect Control. 2016;11:1–47. Scholar
  95. 95.
    See I, Iwamoto M, Allen-Bridson K, Horan T, Magill SS, Thompson ND. Mucosal barrier injury laboratory-confirmed bloodstream infection: results from a field test of a new National Healthcare Safety Network definition. Infect Control Hosp Epidemiol. 2013;34:769–76. Scholar
  96. 96.
    Gaur AH, Miller MR, Gao C, et al. Evaluating application of the National Healthcare Safety Network central line-associated bloodstream infection surveillance definition: a survey of pediatric intensive care and hematology/oncology units. Infect Control Hosp Epidemiol. 2013;34:663–70. Scholar
  97. 97.
    National Healthcare Safety Network (NHSN); Centers for Disease Control and Prevention (CDC). National Healthcare Safety Network (NHSN) patient safety component manual. 2018. Available from Accessed 1 Feb 2018.
  98. 98.
    Vaughan AM, Ross R, Gilman MM, Satchell L, Ditaranto S, Reilly AF, Kersun LS, Shanahan A, Coffin SE, Sammons JS. Mucosal barrier injury central-line–associated bloodstream infections: what is the impact of standard prevention bundles? Infect Control Hosp Epidemiol. 2017;38(11):1385–7. Scholar
  99. 99.
    Miller MR, Griswold M, Harris JM II, et al. Decreasing PICU catheter-associated bloodstream infections: NACHRI’s quality transformation efforts. Pediatrics. 2010;125(2):206–13. Scholar
  100. 100.
    Miller MR, Niedner MF, Huskins WC, et al. Reducing PICU central line-associated bloodstream infections: 3-year results. Pediatrics. 2011;128(5). Available at:
  101. 101.
    Solutions for Patient Safety (SPS). SPS prevention bundle: central line associated blood stream infection (CLABSI). In: SPS prevention bundles. 2014.
  102. 102.
    O'Grady NP, Alexander M, Burns LA, Dellinger P, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph A, Rupp ME, Saint S, and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Guidelines for the prevention of intravascular catheter-related infections, 2011. Centers for Disease Control. 2011.
  103. 103.
    Siegel JD, Rhinehart E, Jackson M, Chiarello L, the Healthcare Infection Control Practices Advisory Committee. 2007. 2007 Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings. Accessed 25 Jan 2017 from
  104. 104.
    Zitella LJ, Friese CR, Hauser J, Gobel BH, Woolery M, O’Leary C, Andrews FA. Putting evidence into practice: prevention of infection. Clin J Oncol Nurs. 2006;10(6):739–50. Scholar
  105. 105.
    Stelfox H, Bates D, Redelmeier D. Safety of patients isolated for infection control. JAMA. 2003;290:1899–905.PubMedCrossRefGoogle Scholar
  106. 106.
    Evans HL, Shaffer MM, Hughes MG, Smith RL, Chong TW, Raymond DP, et al. Contact isolation in surgical patients: a barrier to care? Surgery. 2003;134:180–8.PubMedCrossRefGoogle Scholar
  107. 107.
    CDC. Guidelines for environmental control in health-care facilities. MMWR. 2003:52(No. RR--10).Google Scholar
  108. 108.
    Mize L, Harris N, Stokhuyzen A, Avery T, Cash J, Kasse M, Sanborn C, Leonardelli A, Rodgers C, Hockenberry M. Neutropenia precautions for children receiving chemotherapy or stem cell transplantation for cancer. J Pediatr Oncol Nurs. 2014;31:200–10. Scholar
  109. 109.
    Saria M. Preventing and managing infections in neutropenic stem cell transplantation recipients: evidence-based review. Clin J Oncol Nurs. 2011;15(2):133–9. Scholar
  110. 110.
    Costello C. Skin changes. In: Kline N, editor. Essentials of pediatric hematology/oncology nursing: a core curriculum. 4th ed. Chicago: APHON; 2014. p. 234–6.Google Scholar
  111. 111.
    Curley M, Hasbani N, Quigley S, Stellar J, Pasek T, Wypij D, et al. Predicting pressure injury risk in pediatric patients: the Braden QD scale. J Pediatr. 2018;192:189–97. Scholar
  112. 112.
    Razmus I, Bergquist-Beringer S. Pressure injury prevalence and the rate of hospital-acquired pressure injury among pediatric patients in acute care. J Wound Ostomy Continence Nurs. 2017;44(2):110–7. Scholar
  113. 113.
    Friedman B, Berdahl T, Simpson LA, McCormick MC, Owens PL, Andrews R, et al. Annual report on health care for children and youth in the United States: focus on trends in hospital use and quality. Acad Pediatr. 2011;11:263–79. Scholar
  114. 114.
    Schindler C, Mikhailov T, Kuhn E, Christopher J, Conway P, Simpson V, et al. Protecting fragile skin: nursing interventions to decrease development of pressure ulcers in pediatric intensive care. Am J Crit Care. 2011;20(1):26–34. Scholar
  115. 115.
    Curley MAQ, Razmus IS, Roberts KE, Wypij D. Predicting pressure ulcer risk in pediatric patients: the Braden Q scale. Nurs Res. 2003;52(1):22–33.PubMedCrossRefPubMedCentralGoogle Scholar
  116. 116.
    Larson E, Nirenberg A. Evidence-based nursing practice to prevent infection in hospitalized neutropenic patients with cancer. Oncol Nurs Forum. 2004;31(4):717–23. Scholar
  117. 117.
    Ladas EJ, Sacks N, Brophy P, Rogers PC. Standards of nutritional care in pediatric oncology: results from a nationwide survey on the standards of practice in pediatric oncology: a Children’s Oncology Group study. Pediatr Blood Cancer. 2006;46(3):339–44. Scholar
  118. 118.
    Hooke M, Baggott C, Robinson D, Woolery M, Maloney AM, Dulczak S, et al. Managing disease-and treatment-related complications in pediatric oncology. In: Baggott C, Fochtman D, Foley GV, Kelly KP, editors. Nursing care of children and adolescents with cancer and blood disorders. 4th ed. Glenview: Association of Pediatric Hematology/Oncology Nurses; 2011. p. 510–84.Google Scholar
  119. 119.
    CDC Centers for Disease Control and Prevention [Internet]. BMI Percentile calculator for child and teen 2018 [cited 2018 Feb 21]. Available from:
  120. 120.
    Trimpe K, Shaw MR, Wilson M, Haberman MR. Review of the effectiveness of enteral feeding in pediatric oncology patients. J Pediatr Oncol Nurs. 2017;34(6):439–45. Scholar
  121. 121.
    DeSwarte-Wallace J, Firouzbakhsh S, Finklestein JZ. Using research to change practice: enteral feedings for pediatric oncology patients. J Pediatr Oncol Nurs. 2001;18(5):217–23.PubMedCrossRefGoogle Scholar
  122. 122.
    Skolin I, Hursti UKK, Wahlin YB. Parents’ perception of their child’s food intake after the start of chemotherapy. J Pediatr Oncol Nurs. 2001;18(3):124–36.PubMedCrossRefGoogle Scholar
  123. 123.
    Weinstein R. Red blood cell transfusion: a pocket guide for the clinician. 2016. Available from: RedCellsTxPocketGuideWEB2016.pdf
  124. 124.
    Andrews J, Galel S, Wong W, Glader B. Hematologic supportive care for children with cancer. In: Pizzo P, Poplack P, editors. Principles and practice of pediatric oncology. 7th ed. Philadelphia: Wolters Kluwer; 2016. p. 991–1007.Google Scholar
  125. 125.
    Carson JL, Guyatt G, Heddle NM, Grossman BJ, Cohn CS, Fung MK, et al. Clinical practice guidelines from the AABB: red blood cell transfusion thresholds and storage. JAMA. 2016;316(19):2025–35. Scholar
  126. 126.
    Conte T. Blood product support. In: Kline N, editor. Essentials of pediatric hematology/oncology nursing: a core curriculum. 4th ed. Chicago: APHON; 2014. p. 289–94.Google Scholar
  127. 127.
    Burke ML, Salani D. Hematologic and oncologic emergencies requiring critical care. In: Hazinski MF, editor. Nursing care of the critically ill child. 3rd ed. St. Louis: Elsevier; 2013. p. 825–50.Google Scholar
  128. 128.
    Slichter SJ. Evidence-based platelet transfusion guidelines. Hematology. 2007;1:172–8. Available from: Scholar
  129. 129.
    Nester T, Shweta J, Poisson J. Hemotherapy decisions and their outcomes. In: Fung M, Grossman B, Hillyer C, Westhoff C, editors. Technical manual. 18th ed. Bethesda: AABB. p. 499–544.Google Scholar
  130. 130.
    Jackups R, Savage W. Gaps in research on adverse events to transfusion in pediatrics. Transfus Med Rev. 2016;30(4):209–12. Scholar
  131. 131.
    Spinella PC, Dressler A, Tucci M, Carroll CL, Rosen RS, Hume H, et al. Survey of transfusion policies at US and Canadian children’s hospitals in 2008 and 2009. Transfusion. 2010;50(11):2328–35. Scholar
  132. 132.
    Josephson C, Meyer E. Neonatal and pediatric transfusion practice. In: Fung M, Grossman B, Hillyer C, Westhoff C, editors. Technical manual. 18th ed. Bethesda: AABB. p. 571–97.Google Scholar
  133. 133.
    Bryant R, Norville R. Management of blood component deficiencies. In: Baggott C, Fochtman D, Foley GV, Kelly KP, editors. Nursing care of children and adolescents with cancer and blood disorders. 4th ed. Glenview: Association of Pediatric Hematology/Oncology Nurses; 2011. p. 585–611.Google Scholar
  134. 134.
    Mazzei C, Popovsky M, Kopko P. Noninfectious complications of blood transfusion. In: Fung M, Grossman B, Hillyer C, Westhoff C, editors. Technical manual. 18th ed. Bethesda: AABB. p. 665–96.Google Scholar
  135. 135.
    Silliman CC. The two-event model of transfusion-related acute lung injury. Crit Care Med. 2006;34(5 SUPPL) Scholar
  136. 136.
    Sanchez R, Toy P. Transfusion related acute lung injury: a pediatric perspective. Pediatr Blood Cancer. 2005;45(3):248–55. Scholar
  137. 137.
    American Association of Blood Banks. Standards for blood banks and transfusion services. 29th edition. Summary of significant changes. Available from:
  138. 138.
    Neuss MN, Polovich M, McNiff K, Esper P, Gilmore TR, LeFebvre KB, et al. 2013 updated American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards including standards for the safe administration and management of oral chemotherapy. J Oncol Pract. 2013;9(2 Suppl):5s–13s. Scholar
  139. 139.
    Belderson KM, Billett AL. Chemotherapy safety standards: a pediatric perspective. J Pediatr Oncol Nurs. 2017;34:156–9. Scholar
  140. 140.
    Neuss MN, Gilmore TR, Belderson KM, Billett AL, Conti-Kalchik T, Harvey BE, et al. 2016 updated American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Administration Safety Standards, Including Standards for Pediatric Oncology. J Oncol Pract. 2016;12(12):1262–71. Available from: Scholar
  141. 141.
    Oncology Nursing Society. Education of the nurse who administers and cares for the individual receiving chemotherapy, targeted therapy, and immunotherapy. Position statement. 2017. Available from:
  142. 142.
    James J. A new, evidence-based estimate of patient harms associated with hospital care. J Patient Saf. 2013;9(3):122–8. Available from:,_Evidence_based_Estimate_of_Patient_Harms.2.aspxPubMedCrossRefPubMedCentralGoogle Scholar
  143. 143.
    Mueller BU, Billett AL. Maximizing safety in cancer treatment. In: Pizzo P, Poplack P, editors. Principles and practice of pediatric oncology. 7th ed. Philadelphia: Wolters Kluwer; 2016. p. 452–61.Google Scholar
  144. 144.
    Institute for Safe Medication Practices (ISMP). ISMP’s list of high-alert medications in acute care settings. 2014. Available from:
  145. 145.
    Nixon C, Rae ML. Administration considerations. In: Kline N, editor. The pediatric chemotherapy and biotherapy curriculum. 3rd ed. Chicago: APHON; 2011. p. 73–104.Google Scholar
  146. 146.
    Unger JM, Cook E, Tai E, Bleyer A. The role of clinical trial participation in cancer research: barriers, evidence, and strategies. Am Soc Clin Oncol Meet In: Am Soc Clin Oncol Educ book. 2016;35:185–98. Available from: Scholar
  147. 147.
    Wong D, Baker C. Pain in children: comparison of assessment scales. Pediatr Nurs. 1988;14(1):9–17.PubMedPubMedCentralGoogle Scholar
  148. 148.
    Whaley L, Wong D. Nursing care of infants and children. 4th ed. St Louis; 1991. p. 1148.Google Scholar
  149. 149.
    von Baeyer CL, Spagrud LJ, McCormick JC, Choo E, Neville K, Connelly MA. Three new datasets supporting use of the Numerical Rating Scale (NRS-11) for children’s self-reports of pain intensity. Pain. 2009;143(3):223–7. Scholar
  150. 150.
    Shields BJ, Cohen DM, Harbeck-Weber C, Powers JD, Smith GA. Pediatric pain measurement using a visual analogue scale: a comparison of two teaching methods. Clin Pediatr. 2003;42:227–34.CrossRefGoogle Scholar
  151. 151.
    World Health Organization (WHO). WHO guidelines on the pharmacological treatment of persisting pain in children with medical illness. Geneva: World Health Organization; 2012. Scholar
  152. 152.
    Merkel F, Voepel SI, Lewis T, Shayevitz JR, Malviya S. FLACC Behavioral Pain Assessment Scale. Pediatr Nurs. 1997;23(3):293–7.PubMedPubMedCentralGoogle Scholar
  153. 153.
    Manworren RC, Hynan LS. Clinical validation of FLACC: preverbal patient pain scale. Pediatr Nurs. 2003;29(2):140–6.PubMedGoogle Scholar
  154. 154.
    Voepel-Lewis T, Merkel S, Tait AR, Trzcinka A, Malviya S. The reliability and validity of the face, legs, activity, cry, consolability observational tool as a measure of pain in children with cognitive impairment. Anesth Analg. 2002;95:1224–9.PubMedCrossRefGoogle Scholar
  155. 155.
    Voepel-Lewis T, Zanotti J, Dammeyer JA, Merkel S. Reliability and validity of the face, legs, activity, cry, consolability behavioral tool in assessing acute pain in critically ill patients. Am J Crit Care. 2010;19(1):55–61. Scholar
  156. 156.
    Fanurik D, Koh JL, Schmitz ML, Harrison RD, Conrad TM. Children with cognitive impairment: parent report of pain and coping. J Dev Behav Pediatr. 1999;20(4):228–34.PubMedCrossRefGoogle Scholar
  157. 157.
    von Baeyer CL, Spagrud LJ. Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years. Pain. 2007;127(1–2):140–50. Scholar
  158. 158.
    Dorfman TL, Sumamo E, Rempel GR, Scott SD, Hartling L. An evaluation of instruments for scoring physiological and behavioral cues of pain, non-pain related distress, and adequacy of analgesia and sedation in pediatric mechanically ventilated patients: a systematic review. Int J Nurs Stud. 2014;51(4):654–76. Scholar
  159. 159.
    Curley MAQ, Harris SK, Fraser K, Johnson R, Arnold JH. State behavioral scale: a sedation assessment instrument for infants and young children supported on mechanical ventilation. Pediatr Crit Care Med. 2006;7(2):107–14. Scholar
  160. 160.
    Ambuel B, Hamlett KW, Marx CM, Blumer JL. Assessing distress in pediatric intensive care environments: the COMFORT scale. J Pediatr Psychol. 1992;17(1):95–109.PubMedCrossRefGoogle Scholar
  161. 161.
    Van Dijk M, De Boer JB, Koot HM, Tibboel D, Passchier J, Duivenvoorden HJ. The reliability and validity of the COMFORT scale as a postoperative pain instrument in 0 to 3-year-old infants. Pain. 2000;84:367–77.PubMedCrossRefGoogle Scholar
  162. 162.
    Simone S, Sorce L. Analgesia, paralytics, sedation, and withdrawal. In: Reuter-Rice K, Bolick B, editors. Pediatric acute care: a guide for interprofessional practice. Burlington: Jones & Barlett Learning; 2015. p. 151–87.Google Scholar
  163. 163.
    Zernikow B, Meyerhoff U, Michel E, Wiesel T, Hasan C, Janssen G, Kuhn N, Kontny U, Fengler R, Görtitz I, Andler W. Pain in pediatric oncology – children’s and parents’ perspectives. Eur J Pain. 2005;9:395–406. Scholar
  164. 164.
    Jodarski K, Wilson K. Pain. In: Kline N, editor. Essentials of pediatric oncology nursing: a core curriculum. 2nd ed. APHON: Chicago; 2004. p. 155–9.Google Scholar
  165. 165.
    Dolan EA, Paice JA, Wile S. Managing cancer-related pain in critical care settings. AACN Adv Crit Care. 2011;22(4):365–78. Scholar
  166. 166.
    Kudchadkar SR, Yaster M, Punjabi NM. Sedation, sleep promotion, and delirium screening practices in the care of mechanically ventilated children: a wake-up call for the pediatric critical care community. Crit Care Med. 2014;42(7):1592–600. Scholar
  167. 167.
    Curley MA, Wypij D, Watson RS, Grant MJ, Asaro LA, Cheifetz IM, Dodson BL, Franck LS, Gedeit RG, Angus DC, et al. Protocolized sedation vs usual care in pediatric patients mechanically ventilated for acute respiratory failure: a randomized clinical trial. JAMA. 2015;313(4):379–89. Scholar
  168. 168.
    Dreyfus L, Javouhey E, Denis A, Touzet S, Bordet F. Implementation and evaluation of a paediatric nurse-driven sedation protocol in a paediatric intensive care unit. Ann Intensive Care. 2017;7:36. Scholar
  169. 169.
    Gaillard-Le Roux G, Liet JM, Bourgoin P, Legrand A, Roze JC, Joram N. Implementation of a nurse-driven sedation protocol in a PICU decreases daily doses of midazolam. Pediatr Crit Care Med. 2017;18:e9–e17. Scholar
  170. 170.
    Jacob E. Pain. In: Kline N, editor. Essentials of pediatric hematology/oncology nursing: a core curriculum. 4th ed. APHON: Chicago; 2014. p. 244–52.Google Scholar
  171. 171.
    Kennedy RM, Luhmann J, Zempsky WT. Clinical implications of unmanaged needle-insertion pain and distress in children. Pediatrics. 2008;122(Supplement 3):S130–3. Scholar
  172. 172.
    Padula M. Renal and bladder complications. In: Kline N, editor. Essentials of pediatric hematology/oncology nursing: a core curriculum. 4th ed. Chicago: APHON; 2014. p. 232–4.Google Scholar
  173. 173.
    Czaja AS, Zimmerman JJ. The use of dexmedetomidine in critically ill children. Pediatr Crit Care Med. 2009;10(3):381–6. Scholar
  174. 174.
    Grant MJC, Schneider JB, Asaro LA, et al. Dexmedetomidine use in critically ill children with acute respiratory failure. Pediatr Crit Care Med. 2016;17(12):1131–41. Scholar
  175. 175.
    Phan H, Nahata MC. Clinical uses of dexmedetomidine in pediatric patients. Paediatr Drugs. 2008;10(1):49–69. Scholar
  176. 176.
    Jouguelet-Lacoste J, La Colla L, Schilling D, Chelly JE. The use of intravenous infusion or single dose of low-dose ketamine for postoperative analgesia: a review of the current literature. Pain Med. 2015;16(2):383–403. Scholar
  177. 177.
    Fitzgibbon EJ, Hall P, Schroder C, Seely J, Viola R. Low dose ketamine as an analgesic adjuvant in difficult pain syndromes: a strategy for conversion from parenteral to oral ketamine. J Pain Symptom Manag. 2002;23(2):165–70. Scholar
  178. 178.
    Finkel JC, Pestieau SR, Quezado ZMN. Ketamine as an adjuvant for treatment of cancer pain in children and adolescents. J Pain. 2007;8(6):515–21. Scholar
  179. 179.
    Zempsky WT, Loiselle KA, Corsi JM, Hagstrom JN. Use of low-dose ketamine infusion for pediatric patients with sickle cell disease-related pain: a case series. Clin J Pain. 2010;26:163–7. Scholar
  180. 180.
    Neri CM, Pestieau SR, Darbari DS. Low-dose ketamine as a potential adjuvant therapy for painful vaso-occlusive crises in sickle cell disease. Paediatr Anaesth. 2013;23(8):684–9. Scholar
  181. 181.
    Feudtner C, Freedman J, Kang T, Womer JW, Dai D, Faerber J. Comparative effectiveness of senna to prevent problematic constipation in pediatric oncology patients receiving opioids: a multicenter study of clinically detailed administrative data. J Pain Symptom Manag. 2014;48(2):272–80. Scholar
  182. 182.
    O’Hanlon Curry J, Nixon C. Gastrointestinal complications. In: Kline N, editor. Essentials of pediatric hematology/oncology nursing: a core curriculum. 4th ed. Chicago: APHON; 2014. p. 221–32.Google Scholar
  183. 183.
    Rodrigues A, Wong C, Mattiussi A, Alexander S, Lau E, Dupuis LL. Methylnaltrexone for opioid-induced constipation in pediatric oncology patients. Pediatr Blood Cancer. 2013;60:1667–70. Scholar
  184. 184.
    Flerlage JE, Baker JN. Methylnaltrexone for opioid-induced constipation in children and adolescents and young adults with progressive incurable cancer at the end of life. J Palliat Med. 2015;18(7):631–3. Scholar
  185. 185.
    Anghelescu D, Faughnan L, Hankins G, Ward D, Oakes L. Methadone use in children and young adults at a cancer center – a retrospective study. J Opioid Manag. 2011;7(5):353–61.PubMedPubMedCentralCrossRefGoogle Scholar
  186. 186.
    Anghelescu DL, Patel RM, Mahoney DP, et al. Methadone prolongs cardiac conduction in young patients with cancer-related pain. J Opioid Manag. 2016;12(2):131–8. Scholar
  187. 187.
    Madden K, Park M, Liu D, Bruera E. The frequency of QTc prolongation among pediatric and young adult patients receiving methadone for cancer pain. Pediatr Blood Cancer. 2017;64(11) Scholar
  188. 188.
    Haenecour AS, Seto W, Urbain CM, Stephens D, Laussen PC, Balit CR. Prolonged dexmedetomidine infusion and drug withdrawal in critically ill children. J Pediatr Pharmacol Ther. 2017;22(6):453–60. Scholar
  189. 189.
    Franck LS, Harris S, Soetenga D, Amling J, Curley M. The Withdrawal Assessment Tool-1 (WAT-1): an assessment instrument for monitoring opioid and benzodiazepine withdrawal symptoms in pediatric patients. Pediatr Crit Care Med. 2008;9(6):573–80. Scholar
  190. 190.
    Macpherson CF. Sedation for painful procedures. In: Kline N, editor. Essentials of pediatric hematology/oncology nursing: a core curriculum. 4th ed. Chicago: APHON; 2014. p. 267–8.Google Scholar
  191. 191.
    American Society of Anesthesiology. Committee on Quality Management and Departmental Administration. Continuum of depth of sedation: definition of general anesthesia and levels of sedation/analgesia. 2014. Accessed from
  192. 192.
    Cote CJ, Wilson S. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures: update 2016. Pediatrics. 2016;138(1):e20161212–e20161212. Scholar
  193. 193.
    American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology. Practice guidelines for moderate procedural sedation and analgesia 2018. Anesthesiology. 2018;128:437–79. Scholar
  194. 194.
    Dahan A, Aarts L, Smith TW. Incidence, reversal, and prevention of opioid-induced respiratory depression. Anesthesiology. 2010;112(1):226–38. Scholar
  195. 195.
    Macpherson CF. Psychological preparation and support for painful procedures. In: Kline N, editor. Essentials of pediatric hematology/oncology nursing: a core curriculum. 4th ed. Chicago: APHON; 2014. p. 264–7.Google Scholar
  196. 196.
    Oakes L. Pain causes and treatment. In: Baggott C, Fochtman D, Foley G V, Kelly KP. Nursing care of children and adolescents with cancer and blood disorders. 4th ed. Chicago: Association of Pediatric Hematology/Oncology Nurses; 2011. p. 642–668.Google Scholar
  197. 197.
    Duncan J, Kobler K. Communication in pediatrics. In: Dahlin C, Coyne P, Ferrell B, editors. Advanced practice palliative care. 3rd ed. New York: Oxford; 2016. p. 597–608.CrossRefGoogle Scholar
  198. 198.
    Brennan CW, Prince-Paul M, Wiencek CA. Providing a “good death” for oncology patients during the final hours of life in the intensive care unit. AACN Adv Crit Care. 2011;22(4):379–96. Scholar
  199. 199.
    Anghelescu D, Hamilton H, Faughnan L, Johnson L, Baker J. Pediatric palliative sedation therapy with propofol: recommendations based on experience in children with terminal cancer. J Palliat Med. 2012;15(10):1082–90. Scholar
  200. 200.
    Hooke MC, Grund E, Quammen H, Miller B, McCormick P, Bostrom B. Propofol use in pediatric patients with severe cancer pain at the end of life. J Pediatr Oncol Nurs. 2007;24(1):29–34. Scholar
  201. 201.
    Rohaly-Davis J, Johnston K. A new collaborative practice: critical care and hematology/oncology--altering the misconceptions. Crit Care Nurs Q. 1996;18(4):61–5.PubMedCrossRefPubMedCentralGoogle Scholar
  202. 202.
    Demaret P, Pettersen G, Hubert P, Teira P, Emeriaud G. The critically-ill pediatric hemato-oncology patient: epidemiology, management, and strategy of transfer to the pediatric intensive care unit. Ann Intensive Care. 2012;2(1):1–20. Scholar
  203. 203.
    Pirschel C. Critical care for patients with cancer. Oncol Nurs Forum Voice. 2017;32(7):14–8.Google Scholar
  204. 204.
    American Academy of Pediatrics. Guidelines for developing admission and discharge policies for the pediatric intensive care unit. Pediatrics. 1999;27:843–5.Google Scholar
  205. 205.
    McArthur J, Pettersen G, Jouvet P, Christensen M, Tamburro R. The care of critically ill children after hematopoietic SCT: a North American survey. Bone Marrow Transplant. 2011;46(2):227–31. Scholar
  206. 206.
    Hull CS. Oncology–critical care nursing collaboration. Clin J Oncol Nurs. 2007;11(6):925–8. Scholar
  207. 207.
    Little J. Management in the inpatient setting. In: Reuter-Rice K, Bolic B, editors. Pediatric acute care: a guide for interprofessional practice. Burlington: Jones & Barlett Learning; 2015. p. 97–124.Google Scholar
  208. 208.
    Piastra M, De Luca D, Pietrini D, et al. Noninvasive pressure-support ventilation in immunocompromised children with ARDS: a feasibility study. Intensive Care Med. 2009;35(8):1420–7. Scholar
  209. 209.
    Cogo PE, Poole D, Codazzi D, et al. Outcome of children admitted to adult intensive care units in Italy between 2003 and 2007. Intensive Care Med. 2010;36:1403–9.PubMedCrossRefPubMedCentralGoogle Scholar
  210. 210.
    Kache S, Weiss IK, Moore TB. Changing outcomes for children requiring intensive care following hematopoietic stem cell transplantation. Pediatr Transplant. 2006;10(3):299–303. Scholar
  211. 211.
    Squadrone V, Massaia M, Bruno B, et al. Early CPAP prevents evolution of acute lung injury in patients with hematologic malignancy. Intensive Care Med. 2010;36:1666–74. Scholar
  212. 212.
    Chapman SM, Grocott MPW, Franck LS. Systematic review of paediatric alert criteria for identifying hospitalised children at risk of critical deterioration. Intensive Care Med. 2010;36(4):600–11. Scholar
  213. 213.
    Demmel KM, Williams L, Flesch L. Implementation of the pediatric early warning scoring system on a pediatric hematology/oncology unit. J Pediatr Oncol Nurs. 2010;27(4):229–40. Scholar
  214. 214.
    Swartz C. Recognition of clinical deterioration: a clinical leadership opportunity for nurse executive. J Nurs Adm. 2013;43(7–8):377–81. Scholar
  215. 215.
    Kyriacos U, Jelsma J, Jordan S. Monitoring vital signs using early warning scoring systems: a review of the literature. J Nurs Manag. 2011;19(3):311–30. Scholar
  216. 216.
    Monaghan A. Detecting and managing deterioration in children. Pediatr Care. 2005;17(1):32–5. Scholar
  217. 217.
    Tucker KM, Brewer TL, Baker RB, Demeritt B, Vossmeyer MT. Prospective evaluation of a pediatric inpatient early warning scoring system. J Spec Pediatr Nurs. 2009;14(2):79–85. Scholar
  218. 218.
    Robson MAJ, Cooper CL, Medicus LA, Quintero MJ, Zuniga SA. Comparison of three acute care pediatric early warning scoring tools. J Pediatr Nurs. 2013;28(6):e33–41. Scholar
  219. 219.
    McLellan MC, Gauvreau K, Connor JA. Validation of the children’s hospital early warning system for critical deterioration recognition. J Pediatr Nurs 2017;32:52–58. Available from: Scholar
  220. 220.
    Gawronski O, Ciofi degli Atti ML, Di Ciommo V, Cecchetti C, Bertaina A, Tiozzo E, Raponi M, the Stem Cell Transplant Unit Bedside PEWS Study Group. Accuracy of bedside paediatric early warning system (Bedside PEWS) in a pediatric stem cell transplant unit. J Pediatr Oncol Nurs. 2016;33(4):249–56. Scholar
  221. 221.
    Dingley C, Daugherty K, Derieg MK, Persing R. Improving patient safety through provider communication strategy enhancements. In: Henriksen K, Battles JB, Keyes MA, Grady ML, editors. Advances in patient safety: new directions and alternative approaches. Vol. 3: performance and tools. Agency for Healthcare Research and Quality: Rockville; 2008. Available from: Scholar
  222. 222.
    Lee S-H, Phan PH, Dorman T, Weaver SJ, Pronovost PJ. Handoffs, safety culture, and practices: evidence from the hospital survey on patient safety culture. BMC Health Serv Res. 2016;16(1):254. Available from: Scholar
  223. 223.
    Starmer AJ, Spector ND, Srivastava R, Allen AD, Landrigan CP, Sectish TC. I-PASS, a mnemonic to standardize verbal handoffs. Pediatrics. 2012;129(2):201–4. Available from: Scholar
  224. 224.
    American Association of Critical Care Nurses (AACN). AACN standards for establishing and sustaining healthy work environments: a journey to excellence, 2nd edition. 2016. Available from
  225. 225.
    Stewart B, et al. Perceptions of collaboration and communication between the RN-MD relationship in an oncology ICU. Oncol Nurs Forum. 2008;35(3):488.Google Scholar
  226. 226.
    Kaplow R. Special nursing considerations. Crit Care Clin. 2001;17(3):769–89. Scholar
  227. 227.
    Leary B, Mott S. Perceptions of nurses caring for pediatric bone marrow transplant patients requiring intensive care level support. Biol Blood Marrow Transplant. 2016;22(3):S113. Scholar
  228. 228.
    American Academy of Pediatrics (AAP). Patient- and family-centered care and the pediatrician’s role. Pediatrics. 2012;129(2):394–404. Available from: Scholar
  229. 229.
    Richards CA, Starks H, MR OC, Doorenbos AZ. Elements of family-centered care in the pediatric intensive care unit. J Hosp Palliat Nurs. 2017;19(3):238–46. Scholar
  230. 230.
    Doorenbos A, Curtis JR. Palliative care in the pediatric ICU: challenges and opportunities for family-centered practice. Soc Work End Life Palliat Care. 2012;8(4):297–315. Scholar
  231. 231.
    Gallagher R, Gormley D. Perceptions of stress, burnout, and support systems in pediatric bone marrow transplantation nursing. Clin J Oncol Nurs. 2009;13(6) Scholar
  232. 232.
    Sabo BM. Compassionate presence: the meaning of hematopoietic stem cell transplant nursing. Eur J Oncol Nurs. 2011;15(2):103–11. Scholar
  233. 233.
    Cook KA, Mott S, Lawrence P, Jablonski J, Grady MR, Norton D, et al. Coping while caring for the dying child: nurses’ experiences in an acute care setting. J Pediatr Nurs 2012; 27(4):e11–e21. Available from: Scholar
  234. 234.
    Conte TM. The lived experience of work-related loss and grief among pediatric oncology nurses. J Hosp Palliat Nurs [Internet]. 2014;16(1):40–6. Scholar
  235. 235.
    Berger J, Polivka B, Smoot EA, Owens H. Compassion fatigue in pediatric nurses. J Pediatr Nurs. 2015;30(6):11–7. Scholar
  236. 236.
    Leung D, Fillion L, Duval S, Brown J, Rodin G, Howell D. Meaning in bone marrow transplant nurses’ work: experiences before and after a meaning-centered intervention. Cancer Nurs. 2012;35(5):374–81. Scholar
  237. 237.
    Moody K, Kramer D, Santizo RO, Magro L, Wyshogrod D, Ambrosio J, et al. Helping the helpers: mindfulness training for burnout in pediatric oncology-a pilot program. J Pediatr Oncol Nurs. 2013;30(5):275–84. Scholar
  238. 238.
    Morrison CF, Morris EJ. The practices and meanings of care for nurses working on a pediatric bone marrow transplant unit. J Pediatr Oncol Nurs. 2017;34(3):214–21. Scholar
  239. 239.
    Zander M, Hutton A. Paediatric oncology nursing: working and coping when kids have cancer – a thematic review. Neonatal, Paediatr Child Heal Nurs. 2009;12(3):15–27. Scholar
  240. 240.
    Rushton CH, Batcheller J, Schroeder K, Donohue P. Burnout and resilience among nurses practicing in high-intensity settings. Am J Crit Care. 2015;5:412–20. Scholar
  241. 241.
    Stamm BH. The concise ProQOL manual. 2nd ed. Pocatello:; 2010.Google Scholar
  242. 242.
    Yoder EA. Compassion fatigue in nurses. Appl Nurs Res. 2010;23(4):191–7. Scholar
  243. 243.
    Joinson C. Coping with compassion fatigue. Nursing. 1992;22(4):116, 118–120.Google Scholar
  244. 244.
    Lombardo B, Eyre C. Compassion fatigue: a nurse’s primer. Online J Issues Nurs. 2011;16:3.PubMedGoogle Scholar
  245. 245.
    Jameton A. Nursing practice: the ethical issues. Englewood Cliffs: Prentice-Hall; 1984. p. 6.Google Scholar
  246. 246.
    Jameton A. What moral distress in nursing history could suggest about the future of health care. AMA J Ethic. 2017;19(6):617–28. Available from: Scholar
  247. 247.
    Rushton CH. Defining and addressing moral distress tools for critical care nursing leaders. AACN Adv Crit Care. 2006;17(2):161–8. Available from: Scholar
  248. 248.
    Dudzinski DM. Navigating moral distress using the moral distress map. J Med Ethics. 2016;42(5):321–4. Scholar
  249. 249.
    Leung D, Esplen MJ, Peter E, Howell D, Rodin G, Fitch M. How haematological cancer nurses experience the threat of patients’ mortality. J Adv Nurs. 2012;68(10):2175–84. Scholar
  250. 250.
    Barnard D, Street A, Love AW. Relationships between stressors, work supports, and burnout among cancer nurses. Cancer Nurs. 2006;29(4):338–45.PubMedCrossRefGoogle Scholar
  251. 251.
    Trousselard M, Dutheil F, Naughton G, Cosserant S, Amadon S, Dualé C, et al. Stress among nurses working in emergency, anesthesiology and intensive care units depends on qualification: a Job Demand-Control survey. Int Arch Occup Environ Health. 2016;89(2):221–9. Scholar
  252. 252.
    Pavlish C, Brown-Saltzman K, So L, Wong J. SUPPORT: an evidence-based model for leaders addressing moral distress. J Nurs Adm. 2016;46(6):313–20.PubMedPubMedCentralGoogle Scholar
  253. 253.
    Hiler CA, Hickman RL Jr, Reimer AP, Wilson K. Predictors of moral distress in a us sample of critical care nurses. Am J Crit Care. 2018;27(1):59–66. Scholar
  254. 254.
    Aiken LH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002;288(16):1987. Available from: Scholar
  255. 255.
    Meadors P, Lamson A. Compassion fatigue and secondary traumatization: provider self care on intensive care units for children. J Pediatr Heal Care. 2008;22(1):24–34. Scholar
  256. 256.
    Wocial LD, Weaver MT. Development and psychometric testing of a new tool for detecting moral distress: the moral distress thermometer. J Adv Nurs. 2013;69(1):167–74. Scholar
  257. 257.
    Maslach C, Jackson SE, Leiter MP. Maslach burnout inventory manual. 3rd ed. Palo Alto: Consulting Psychologists Press; 1996.Google Scholar
  258. 258.
    Zomorodi M, Lynn MR. Instrument development measuring critical care nurses’ attitudes and behaviors with end-of-life care. Nurs Res. 2010;59(4):234–40. Scholar
  259. 259.
    Rushton CH. Moral resilience: a capacity for navigating moral distress in critical care. AACN Adv Crit Care. 2016;27(1):111–9. Scholar
  260. 260.
    AACN. The 4 A’s to rise above moral distress. 2012. Available from
  261. 261.
    Kelly LA, Lefton C. Effect of meaningful recognition on critical care nurses’ compassion fatigue. Am J Crit Care. 2017;26(6):438–44. Scholar
  262. 262.
    Johnson LM, Church CL, Metzger M, Baker JN. Ethics consultation in pediatrics: long-term experience from a pediatric oncology center. Am J Bioeth. 2015;15(5):3–17. Scholar
  263. 263.
    Robinson EM, Lee SM, Zollfrank A, Jurchak M, Frost D, Grace P. Enhancing moral agency: clinical ethics residency for nurses. Hast Cent Rep. 2014;44(5):12–20. Scholar
  264. 264.
    Hinds PS, Puckett P, Donohoe M, Milligan M, Payne K, Phipps S, Davis SE, Martin GA. The impact of a grief workshop for pediatric oncology nurses on their grief and perceived stress. J Pediatr Nurs. 1994;9(6):388–97.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing 2019

Authors and Affiliations

  • Brienne Leary
    • 1
    Email author
  • Barbara Cuccovia
    • 2
  • Colleen Nixon
    • 3
  1. 1.Pediatric Medical-Surgical Intensive Care UnitBoston Children’s HospitalBostonUSA
  2. 2.Pediatric Stem Cell Transplant UnitBoston Children’s HospitalBostonUSA
  3. 3.Pediatric Hematology/Oncology UnitBoston Children’s HospitalBostonUSA

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