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Exchange transfusion

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Exchange transfusion

  1. 1. Presented by: Sabita PaudelB.Sc Nursing 3rd year4/20/2013BPKIHS,Dharan ,Nepal
  2. 2. To exchange all or part of an infant’s blood supply forcertain medical conditions is called exhangetransfusion.•4/20/2013
  3. 3. • A double volume exchange transfusion is replacingthe baby’s total blood volume twice, leaving theintravascular amount the same.• A partial exchange is either increasing or decreasingan infant’s hematocrit, while maintaining a constantblood volume.4/20/2013
  4. 4. • General information• Double Volume ExchangeTry to use the freshest blood available (procured within3-5 days) for the double volume exchange. If wholeblood is not available, use a combination of Freshfrozen plasma and packed red blood cells.4/20/2013
  5. 5. • The exchange volume is twice the infant’s bloodvolume, using 85 ml/kg as the infant’s blood volume.This procedure should be done slowly, over aminimum of 45 minutes and the blood volume shouldbe kept fairly constant. See nursing procedure forfurther information. A consent must first be obtainedfor blood transfusion.4/20/2013
  6. 6. • Partial Exchange• A consent must first be obtained for bloodtransfusion when raising hematocrit. An exchange isusually done for polycythemia when the HCT isbetween 65-72, depending on if infant issymptomatic or not. Use normal saline for anexchange to lower Hct4/20/2013
  7. 7. • An exchange is done to raise the HCT when theinfant has a chronic anemia, with a normal bloodvolume. Use PRBCs to raise Hct. An infants bloodvolume is 85 ml/kg. The desired Hct is usually 50 –55%. Use the following formulas to calculate theamount of the exchange:4/20/2013
  8. 8. • To Lower Hematocrit:• Volume to exchange = (Wt in Kg X 85) X (ObservedHct – Desired Hct)• Observed Hct• To Raise Hematocrit:• Volume to exchange = (Wt in Kg X 85) X (DesiredHct – Observed Hct)• Hct of PRBC’s4/20/2013
  9. 9. MaterialsA Double Volume Exchange• 1. Hat• 2. Mask• 3. Sterile gloves• 4. Sterile gown• 5. Umbilical catheter tray with extra catheters4/20/2013
  10. 10. • 6. Heparinized flush solution• 7. 10 or 20 ml syringes (depending on size of infant)• 8. Blood warmer, filter, and tubing• 9. Whole blood, or FFP and PRBC’s• 10. Calcium Gluconate4/20/2013
  11. 11. • Partial Exchange Transfusion• 1. Hat• 2. Mask• 3. Sterile gloves• 4. Sterile gown• 5. Umbilical catheter tray with extra catheters• 6. Heparinized flush solution4/20/2013
  12. 12. • Double Volume Exchange:• 1.Hyperbilirubemia• 2.Hyperammonimia• 3.To remove bacterial toxins• 4. To correct life-threatening electrolyte and fluidimbalance
  13. 13. Partial volume exchange1. Severe anemia in the face of normal or excess bloodvolume.2. Clinical polycythemia4/20/2013
  14. 14. • Double Volume Exchange• 1. Same complications as UAC & UVC line insertion.• 2. Microemboli• 3. Arrhythmias• 4. Volume overload.4/20/2013
  15. 15. • 5. Cardiac arrest – from too rapid exchange or K+toxicity.• 6. Hyperkalemia, hypernatremia, hypocalcemia• 7.Metabolic acidosis• 8. Respiratory alkalosis• 9. Thrombocytopenia• 10. Infection• 11. Transfusion reaction4/20/2013
  16. 16. Partial Volume Exchange1. Same complications as UAC & UVC line insertion.2. Microemboli3. Infection4. Transfusion reaction5. Anemia or polycythemia4/20/2013
  17. 17. • 1. Perform time out with all appropriate steps.• 2. If two catheters are in place, withdraw 5ml/kgblood from the arterial catheter and infuse 5ml/kgdonor blood through venous cathetersimultaneously.• .4/20/2013
  18. 18. • If only an umbilical venous catheter is in place,withdraw 5 ml/kg of infant’s blood first, then replacewith 5 ml/kg of donor blood.• Continue in 5ml/kg aliquots until desired volume isexchanged.4/20/2013
  19. 19. • 3. Send first blood drawn for pre-exchange bilirubin,blood gas and other lab investigations• 4. The bedside nurse is to maintain strict in/outrecord, monitor vital signs, and blood temperature.• 5. Halfway through the exchange, send blood gasand bilirubin.4/20/2013
  20. 20. • Lab investigations before procedure• (Donor blood - Hct, K, & pH )• Infant –• ABG, Total & direct bilirubin, Na, K, Ca, CBC, Plts,Albumin• During procedure• ABG Q 100 ml if RDS• Glucose screen Q 15-30 minutes4/20/2013
  21. 21. After completionRepeat type and cross• Hct, ABG• Total & direct bilirubin and repeat Q h• X 2 Na, K, Ca, CBC, Platelets , Albumin• Glucose screen at 15 & 30 minutes, then Q 1 hr X 4.4-6 hrs post exchange :• Hematocrit and Total & Direct bilirubin4/20/2013
  22. 22. • Partial Volume Exchange – To lower hematocrit• To Lower Hematocrit:• 1. Perform time out with all appropriate steps.• 2. Exchange the infant’s blood for normal saline, inincrements not to exceed 5% of the estimated totalblood volume.4/20/2013
  23. 23. • Continue until the total exchange volume is reached.• 3.mainintain a post-exchange hematocrit. If the Hctis 55% or greater, take out an additional 5 ml/kg ofinfant’s blood to prevent further hemoconcentration.4/20/2013
  24. 24. • To Raise Hematocrit:• 1. Perform time out with all appropriate steps.• 2. Exchange the infant’s blood for donor blood, inincrements not to exceed 5% of the estimated totalblood volume. Continue until the total exchangevolume is reached.4/20/2013
  25. 25. • E. Follow-up treatment• Double Exchange Transfusion• 1. At completion, send post-exchange labs (seeTable 1).• 2. Resume phototherapy if exchange was done forhyperbilirubinemia.4/20/2013
  26. 26. • 3. Observe in ICN. Do not feed for at least 4 hrsafter umbilical lines removed.• Partial Exchange Transfusion• 1. Send hematocrit at completion of exchange and4 hrs after completion.• 2. Observe in baby for at least 4 hours and do notfeed until at least 4 hrs after umbilical cathetersremoved .4/20/2013