Nurses in the intensive care unit (ICU) generally see patients with cancer only when they are extremely sick—not throughout the extensive cancer journey they go through before they get to the ICU.
Educating and familiarizing ourselves, as ICU nurses, with a patient’s oncology plan, goals, and history can improve overall care. Learning at which points in the process of cancer treatment certain issues are more likely to arise, such as tumor lysis syndrome during high-dose induction, when a patient is most likely to be neutropenic during a stem cell transplant, and other general facts about oncology, can help improve the care we give. It helps us understand our patients as a whole. The oncology population is a huge part of medical intensive care, and encouraging critical care nurses and oncology nurses to collaborate can help improve the continuity of care and eliminate errors in the ICU.
Sepsis, disseminated intravascular coagulation, medication reactions, gastrointestinal bleeding, and anything that requires a smaller nurse-to-patient ratio are common reasons for patients with cancer to be transferred to an ICU, as well as emergencies. I’ve seen patients come to the ICU prophylactically to receive a drug that drops blood pressure, as well as an anaphylaxis reaction to blood products. Septic shock with respiratory failure is common too.
When tracking sepsis, ICU nurses typically look at lactic acid to determine how well a patient is being perfused, as well as arterial blood gases. We see if it is metabolic, respiratory acidosis, alkalosis—just like in nursing school—and we track all the same labs generally that oncology nurses track. We also look at mixed venous oxygen saturation (SvO2) on venous blood gas. SvO2 is related to how responsive a patient is to fluid resuscitation during sepsis. Normal SvO2 is between 60%–80%, and it measures the leftover oxygen returning to the heart. It lets us know if the cardiac output is meeting the oxygen requirements of the body after each fluid bolus. Oncology nurses should be on the lookout for rising lactic acid, rising white blood cell counts, and if blood counts do not improve with transfusions.
As many oncology nurses may already know, it’s important to recognize that the invasive and aggressive stabilization of patients in the ICU can sometimes make it harder for them to resume cancer treatment without additional support. The oncology and critical care teams working together can help develop appropriate goals and specialize the care to fit the patient with cancer.
We all know how quickly patients’ status can change. Early admission to the ICU for first recognition of sepsis or organ failure has shown better outcomes for patients. All too often, it happens that a critically ill patient waits too long for ICU transfer and thus delaying the critical care the patient needs. Oncology nurses and intensive care nurses can work together to create better outcomes for patients with cancer.