- Ensure well-defined guideline for CRS and complications management is in place.
- Ensure guideline is in place for when the patient should be transferred to ICU for critical care
- Nurses must be knowledgeable about the disease, guidelines of Car-T therapy and common adverse event symptoms, especially the different grades of CRS
- Perform vital sign assessment, multi-panel bloodwork, weight check and neurological assessment every visit. Click here for more information about adverse neurological symptoms after Car-T therapy
- Use critical thinking to be able to differentiate the symptoms of CRS from its early onset (Grade one or two) from other conditions such as tumor lysis syndrome, neutropenic sepsis, capillary leak syndrome, adrenal insufficiency
- Advocate to check for proinflammatory cytokine levels, such as Interleukin-6 and CRP level post Car-T therapy
- Make sure emergency equipment is nearby if they are needed
- Administer antipyretic and antihistamine as prophylaxis to prevent complications such as tumour lysis syndrome as directed prior to Kymriah infusion
- Understand the long-term consequences on patient’s health and their quality of life and impact it may have on their families if they are affected by CRS.
- Connect with other members of the Interdisciplinary team such as Social Worker or dietician or spiritual counselor
(CANO, 2020; Lee et al., 2019; Schuster et al., 2019).