# POL-CW-05 — Discharge and after-hours fever advice

**Riverside Children's Cancer Centre — Cedar Ward**
**Owner:** Nursing Education (Ms H. Saleh)
**Version:** 1.4
**Date:** 2 August 2025
**Review due:** 2 August 2026
**Applies to:** families leaving Cedar Ward with a child on chemotherapy
**Status:** current — teaching copy, not a real hospital policy
**Sign-off:** Nursing Education only. Infectious Diseases has not countersigned this leaflet.

## 1. Purpose

To give families a single, plain-language plan for fever and line care after discharge.

## 2. What neutropenia means (for families)

Neutropenia means the **absolute neutrophil count** is low. The absolute neutrophil count is the **white cells plus the bands**. Below 500, infection risk is high.

## 3. If your child has a fever at home

Take a temperature if the child feels hot.

- A temperature of 38.0°C is a **low-grade fever**. If the child looks well, you may give paracetamol and **call the clinic between 08:00 and 16:00 the next working day**.
- A temperature of 38.5°C or higher: call the ward. If it is after 16:00, wait until morning unless the child is drowsy or not drinking.

Do not rush to Emergency for a fever that settles with paracetamol.

## 4. What happens in Emergency

If you do come in, the team aims to give the first antibiotic **within 90 minutes**. Families are told the usual first drug is **ceftriaxone**.

## 5. Line care at home

Every central line is discharged with a **heparin lock**. Flush only if the home-care nurse has shown you how. Do not use saline alone — the line will clot.

## 6. When to come to Emergency tonight

Come tonight if:

- the child is drowsy, mottled, or not drinking
- there is shaking (rigors) after a line flush
- there is bleeding that does not stop

Fever alone, in a child who looks well, can wait for clinic.

## 7. Related documents

- POL-CW-01 Febrile neutropenia — “this leaflet must match the fever pathway”
- POL-CW-02 Central venous access devices