It is difficult to predict the length of stay in the hospital after a stem cell infusion. Many factors will be considered by the Transplant Team in determining your date of discharge. An important factor will be your body’s ability to produce blood cells (white cells, red cells, and platelets). The following are important factors:
- Absolute neutrophil count (ANC) above 1,000 without the need for a daily transfusion of platelets or red cells. In most cases, a count of 1,000 indicates that the marrow is working and producing an adequate number of white blood cells
- Stabilized red and platelet counts without the need for daily transfusions
- Your overall health and management of any side effects or infections
Approximately one week before your discharge, members of the Transplant Team will determine and discuss ways in which you can continue recovery at home with the assistance of your caregiver(s). The social worker can discuss catheter care or home care services, if required. It is important that your primary caregiver be involved in discharge planning and be present on the day of discharge.
Catheter Care at Home
Your catheter (such as a central venous tunneled catheter or PICC line) may be left in place for several weeks following your discharge from the hospital. With the assistance of a home infusion/care company, you will be asked to have the dressing changed once a week and the catheter flushed. A central venous tunneled catheter is flushed three times a week, and a PICC line is flushed daily. You and/or your caregiver will be taught how to administer the flushes, and the dressing will be changed by the nurse visiting your home.
If you experience any of the problems below, immediately contact your doctor’s office, or go to the nearest hospital emergency room for evaluation.
- Redness, drainage of blood or pus, swelling, or pain at the catheter exit site along the neck or chest wall
- Sudden onset of fever and/or chills
- Blood leaking out of the catheter
- Inability to flush the catheter
Follow-up Clinic Visits
After you are discharged from the Transplant Unit, you will need to follow-up with your transplant physician for evaluation. During this time, you will be expected to visit your transplant physician at the outpatient clinic on Starr 3 at least once, or twice a week. It is recommended that you avoid public transportation (to reduce infection risk) and do not drive soon after your transplant. The length of time post-transplant that you should avoid driving is dependent upon your comfort level and ability to handle potential stress related issues that could occur while driving. Therefore, you may consider alternative transportation options, such as having someone drive you to the clinic.
You may also consider exploring local housing options with your caregiver(s) and social worker if you live outside of the New York City metropolitan area and/or you expect travel to the clinic to be difficult. Some complications may require a readmission to our hospital, which will be determined by the Transplant Team at the time of your clinic visit.
When to Call
It is very important to notify your transplant physician if you have any of the following signs or symptoms:
- Fever of 100.5°F (38°C) or higher
- Redness, tenderness or swelling at the insertion site of your tunneled catheter or PICC line
- Sweating or shaking/chills
- Sore throat or pain when swallowing
- Blisters or sores in your mouth or on tongue
- Shortness of breath
- Chest pain
- Cough with phlegm or blood
- Dry, persistent cough
- Skin sores, rash, or itching
- Unusual vaginal/penile discharge
- Unusual bruising
- Bleeding from gums, nose, or rectum
- Blood in your urine or stool
- Painful, burning, and/or frequent urination
- Cloudy or foul-smelling urine