It was Summer of 2013 when I decided to apply for a Registered Nurse

position for the UCH BMT Apheresis Unit. I was working with the
Inpatient Acute Dialysis Unit at that time for almost nine years. Coming
back from my vacation , I was notified by the Human Resources staff
that I got the position. July 1, 2013 I started with my orientation.
I was blessed to have a very familiar face as my preceptor. Nurse M.
used to be my co worker in the Acute Dialysis Unit of UCH. I know her
work ethics, her compassion for her patients and her dedication to
her profession is bar none. I knew she will be the best preceptor for
me. BMT Apheresis Unit is a procedural unit located on the second
floor of the Anschutz Cancer Pavilion. It has only 2 Staff when I joined
the team and I was the third . This unit performs Stem Cell Collection,
Donor Lymphocytes Collection, White Blood Cell Depletion,
Photopheresis, LDL Apheresis, and Therapeutic Phlebotomy. It was a
little bit intimidating to think that I have to learn and master all of
these procedures.
I was on my third week of orientation when the Senior staff who was
an Apheresis technician declared that she was leaving her post and
that leaves just the 2 of us. Nurse M. just joined the team 3 months
ahead of me. We felt like we were Rookies playing for the Super
Bowl. With all the support from each other , our Supervisors , Doctors
and Multi Disciplinary team we were able to keep the unit going well .
The program grew in tremendous pace that by November of that year
we have to hire a third RN. And after another 6 months we have to
hire the 4th RN.
It was Monday morning, Mr. D. was scheduled for his first day of Stem
Cell Collection. I was the RN assigned to do his procedure. He was
diagnosed with Multiple Myeloma . In order for him to have his
transplant done he needs to have Stem Cell Collection done ahead of
time. His collection goal was 10 Million CD34/KG. Then if he meets the
goal , he will be admitted in the Inpatient BMT/ Oncology Unit. Next
Chemotherapy will be administered to wipe out everything in his
blood, both Cancer Cells and healthy cells alike. 5 Million of his Stem
Cells will be transplanted to him and another 5 million will serve as
back up. He showed up at 0700 in the morning with his wife. I
introduced myself to be his RN and the rest of the team as well. I told
him that we will draw his labs right away and wait for the result of his
CBC before we would start the procedure. The nurse practitioner also
assessed him that morning and gave the go signal that the patient is
ok for stem cell collection .
While doing the lab draw , I noticed that Mr. Ds Trifusion catheter on
his left IJ was bleeding . It was just placed yesterday . I told him that

bleeding on the exit site of newly placed access is not uncommon and
changing the soaked dressing with a pressure dressing might do the
trick. Pre procedure Vital signs showed he had Temporal Temp at 38.2
C with mild generalized bone pain. He seemed a little bit
apprehensive at the start of our encounter. I reassured him that
generalized bone pain is usually a side effect of the mobilizing agent
Neupogen that he received .( Neupogen 900 mcg daily for 4 days daily
before the collection). Bone pain is a good indicator that his bone
marrows are in overdrive to produce more stem cells. I also reassured
him that the low grade fever was mostly a side effect from the
Neupogen. I told him that we will draw blood cultures as ordered that
day to rule out any infection. The patient and his wife all agreed to our
plans. While waiting for the results I turned on the Spectra Optia
Apheresis machine and primed it, inspect it , and made sure it passed
all the test so that it could be safely used for Stem Cell Collection.
CBC results came back exactly after an hour . I asked him if he would
like to go to the bathroom, now is the good timing for it. After he will be
connected to the machine , we could not disconnect him until he is
done for the day, unless it is an emergency like fire or tornado. Patient
went to the bathroom first and we started his Stem cell collection at
0806 in the morning. I gave him Tylenol 650 mg orally for fever and
pain. I did also apply ice pack to his forehead. I reminded the patient
that this procedure is painless but he could experience other
symptoms. The most common one is numbness and tingling to lips, an
early indication of low Calcium in the blood. ACDA [Citrate] is used as
anticoagulant for this procedure . It binds Calcium in the blood in order
to interrupt the clotting cascade. Calcium Gluconate is being used as
the calcium replacement and is infused to the patient via the return
line using a weight based formula. Some patients are more sensitive
to Calcium changes in their blood that they need a slightly higher rate.
I pointed out to him that he should report to us any new symptoms
that he experienced right away . The earlier he tells us the sooner we
can fix the symptoms and avoid a more serious side effect . This
includes but are not limited to numbness and tingling to lips and
tongue , dizziness, nausea and vomiting, All of these are explained to
them by the Dr. consenting the procedure ahead of time but I noticed
in the past patient and family sometimes forgot about these important
informations. This procedure is usually long and could take 6 to 8
hours. I did monitor the patients Temperature every one to two hours
and it did not drop lower tha 37.7 C. and the highest was 38.4 C.
During the procedure the patient asked why there were occasional
alarms. I reassured the patient that alarm is our friend and helps us fix
some issues that needs attention right away. I did also offered him
urinal and commode at the time that he needed them. 6 to 8 hours of

sitting in a chair is not easy for a lot of people . I told him he could
watch tv, read magazines or books , play games on his computer or
even take a nap. The wife even took pictures during the procedure. To
make his boring day a little bit exciting I whispered to him that we can
make bets on how much stem cells he will collect that day. I told him
that gambling is strictly prohibited in the hospital campus so we
decided to have 3 Packs of Oreo cookies as our price. Whoever guess
the closest number of Stem Cells collected without going over wins..
BMT program offers free snacks and drinks to our patients and family
one of which is Oreo cookies . He immediately said sure including
his wife. The patient said Im guessing 10.5 Million, I said 11 million,
His wife said 12 Million and my co- worker said 11.7 million. 2 hours
after I sent the pre procedure labs , we could get a Predicted yield
using our formula how much we will collect that day. Predicted yield for
that day was 11.68 Million CD34/KG.
After agonizing 6.5 hours , the procedure was over , I had to rinsed
back the blood to the patient. I sent the post procedure labs to the
Laboratory and the Staff from Clin Immune was there to pick up the
product bag that we collected. We need to wait for another 1.5 to 2
hours to get the final counts from Flow Cytometry, then the NP and MD
will decide if we need to collect again the next day. I had to give him
another dose of Tylenol at this time as his temp was still 38.2C. We
had to send him for Chest X ray to rule out Pneumonia . Then
Levofloxacin 500 mg tablet X 7 days daily was prescribed for empiric
coverage.
After 2 hours I got the results back. Stem Cells collected was 15.81
Million. I looked at our sheet and the wife won. I called the patient on
his cell phone and told him about the result. After 5 mins they were
back in the unit. I could see the smile both on their faces. Everybody
was happy. This time they brought in 3 bigger bags of Oreo cookies.
The patient said you guys did a great job collecting my stem cells.
Lets have an Oreo toast. The patient open one of the bags, give one
oreo to each one of us , and the four of us had the Oreo toast. Since
the goal was met, the patient was done collecting and he does not
need to come back the next day. Mr D. thanked me that day, not just
because we met his collection goal. He told me, Rey you are doing your
job with passion and dedication. I told him Mr. D. since I practice
Nursing I always treat all of my patients as my father , mother, brother
or sister. I want the best care for my own family and I hope that if my
own family is sick they will be treated the same way. He was
discharged from the unit via wheelchair with his wife.
3 days after Mr. D. was done with his collection, He came back with his
wife and children. His Chest X- ray was negative so was his Blood

cultures. He brought with them a thank you card and a picture frame. It
was a picture taken during his collection. In that picture he was
pointing to his collection bag and was connected to the machine, I
and my co- worker standing next to him. He said he is going to donate
it to our unit so that we could show it to other patients and family who
will have the same procedure in the future. Looking at that picture
frame I could see three happy faces . No trace of fever , pain , or
human suffering. Deep in my heart I could feel I love being a Nurse.