Nursing care of the child with cancer during intravenous pentamidine infusions

Background: Pentamidine is an antifungal and antiprotozoal agent used in the prevention and treatment of Pneumocystis jirovecii pneumonia (PJP). Children with cancer who are immunosuppressed receive intravenous (IV) pentamidine if they are unable to tolerate the first-line prophylactic agent for PJP, trimethoprim-sulfamethoxazole. Clinical references recommend assessing blood pressure (BP) but do not provide specifics. The purpose of this retrospective study was to describe the incidence of hypotension, infusion rates, and frequency of BP mon-itoring in a cohort of pediatric patients with cancer. Methods: Infusions were evaluated in a convenience sample of children with cancer over a 1-year period in patients ages 1 to 18 years who received prophylactic IV pentamidine outside of the intensive care. Data on infusions and nursing assessments were abstracted from the electronic medical record. Docu-mentation from first and second doses of pentamidine and the two most recent doses were reviewed. Findings: A total of 114 prophylactic pentamidine infusions were evaluated in 30 children with a variety of cancer diagnoses who received infusions in the inpatient oncology unit or outpatient oncology infusion center. All infusions were administered by IV pump over 60 minutes. BP was monitored in 98% of the infu-sions; there were no incidents of hypotension or adverse reactions. Conclusion: Intravenous pentamidine can be safely administered to children who are medically stable, outside of the intensive care setting, over 60 minutes without additional BP measurement beyond norms for the clinical area. Institutional standards were updated; nurses now monitor stable patients with observation and PRN vital signs.