Shaw, N. Assessment and management of haematologic dysfunctions. Kenner, J. Applewhite Flandermeyer, Comprehensive neonatal nursing: A physiologic perspective p Philadelphia: W. Saunders Co. Thayyil S, Milligan D.
Single versus double volume exchange transfusion in jaundiced newborn infants. Cochrane Database of Systematic Reviews , Issue 4. DOI: Exchange transfusion using peripheral vessels is safe and effective in newborn infants.
Exchange Transfusion. Iowa Neonatology Handbook. Effect of exchange transfusion on brain perfusion and electrocortical brain activity in newborn lambs. Biol Neonate. Exchange Transfusion in the Infant. Handbook of Pediatric Transfusion Medicine. Transfusion-associated graft-versus-host disease following exchange transfusion in a newborn.
European Journal of Paediatrics ; 4 Partial exchange transfusion to prevent neurodevelopmental disability in infants with polycythemia. Cochrane Database of Systematic Reviews. Dempsey EM, Barrington K. Short and long term outcomes following partial exchange transfusion in the polycythemic newborn: a systematic review. Neonatal polycythemia: is partial exchange transfusion justified?
Clinics in perinatology. Date last published: 15 October This document is only valid for the day on which it is accessed. Please read our disclaimer. Newborn intensive care. Parental Consent Informed written consent must be obtained. Consent is documented on a consent form Agreement to Treatment CR Consent for blood is documented on the reverse side of form CR Volume N. Procedure Consent must be obtained by the Doctor from the parent s prior to commencement of the exchange transfusion.
Ventilator must be set up ready for use at the bed space. Blood and IV fluids must be prescribed by medical staff on appropriate charts. Asepsis must be maintained throughout the procedure. Nurse the baby on a radiant heat table. If the exchange is being done for hyperbilirubinaemia, ensure optimal exposure to phototherapy and biliblanket is maintained The infants cardiorespiratory status and oxygen saturation must be monitored continuously.
Observe carefully throughout the procedure that there is no air in the lines. Technique Exchange transfusions are performed using either one catheter or two catheter push-pull method. Two Catheter Push-pull Technique Blood is removed from the artery while infusing fresh blood through a vein at the same rate.
Haemolysin negative. Partially packed i. Less than 5 days old. Mix the blood before taking the samples. Each method of exchange transfusion uses the same out line for blood Connect 2 x BC extensions and drain into an empty bottle.
Monitoring and Documentation Record baseline observations prior to commencing exchange transfusion. Observe for any changes in neurological status - drowsiness, irritability. Record blood results on the Exchange Transfusion Results Sheet CR Maintain continuous electronic monitoring of vital signs for at least two hours post transfusion or longer if baby's condition is not stable.
Specimen is to be taken from each unit as soon as it arrives. Collect 0. FBC and differential. Urea, Creatinine, Bilirubin total and direct. Guthrie unless previously done Coagulation screen should be collected if more than one exchange is performed 0. During Exchange Specimen Blood gas, electrolytes and glucose are tested as ordered. FBC and differentials Urea, Bilirubin total and direct. Coagulation screen should be performed if more than one exchange.
Complications Be aware of this possibility Observe the baby carefully Have resuscitation equipment ready During Exchange Air embolus Ensure the lines are correctly set up.
Watch the lines continuously for air. Turn the line off instantly if air is seen. Never have a 3 way tap open to air and the baby Be very careful if there are large swings in intrathoracic pressure.
Volume imbalance The nurse is responsible for recording the volume balance throughout the exchange. Arrhythmias Can occur from a variety of causes.
Set the monitor to have an audible QRS complex. Acidosis Blood for exchange transfusion is preserved in CPD citrate, phosphate, dextrose and can be quite acidotic. Check the baby's blood pH before, during usually half way , and after the exchange Check more frequently for a sick, unstable or small baby.
Respiratory distress Monitor respiration and SpO2 constantly. Monitor the QRS complex. Agitate the bag every 15 minutes.
Fluctuating BP and cerebral blood flow Monitor rate of blood in and out carefully. Infection Prophylactic antibiotics are not indicated. Observe closely for signs of infection. However rebound hypoglycaemia may occur afterwards. Thrombocytopenia Very common, and more severe after more exchanges due to increased platelet consumption. Recovers in a few days. Monitor platelets serially for a week post exchange. Polycythaemia or anaemia From poorly mixed or packed blood.
Coagulopathy or neutropenia More likely the multiple transfusions. Necrotising enterocolitis Umbilical catheter related especially with a low UVC and maybe due to BP and blood volume fluctuations. Take care with feeding post exchange Blood transmitted infections For a detailed list refer to Blood Products - RBC guideline Graft versus Host disease There have been several case reports. It seems to be more likely with more preterm infants, intrauterine transfusions, multiple exchanges, and related donors.
Irradiate the donor blood. Initiate resuscitative measures as indicated. If lines and blood pack are removed they must be sent to Blood Bank for proper analysis. Hematology: Basic Principles and Practice. Kliegman RM, St. Blood disorders. In: Kliegman RM, St. Nelson Textbook of Pediatrics.
Watchko JF. Neonatal indirect hyperbilirubinemia and kernicterus. Avery's Diseases of the Newborn. Updated by: Neil K. Editorial team. Exchange transfusion. In diseases such as sickle cell anemia, blood is removed and replaced with donor blood.
Why the Procedure is Performed. An exchange transfusion may be needed to treat the following conditions: Dangerously high red blood cell count in a newborn neonatal polycythemia Rh-induced hemolytic disease of the newborn Severe disturbances in body chemistry Severe newborn jaundice that does not respond to phototherapy with bili lights Severe sickle cell crisis Toxic effects of certain drugs. General risks are the same as with any transfusion. Other possible complications include: Blood clots Changes in blood chemistry high or low potassium, low calcium, low glucose, change in acid-base balance in the blood Heart and lung problems Infection very low risk due to careful screening of blood Shock if not enough blood is replaced.
After the Procedure. Alternative Names. Patient Instructions. Newborn jaundice - discharge.
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