An exchange transfusion involves slowly removing a patient's blood and replacing it with donor blood in order to remove abnormal components and toxins while maintaining blood volume. It is indicated for hyperbilirubinemia, Rhesus/ABO incompatibility, severe anemia, and other conditions. The procedure requires specialized equipment and staffing in a NICU. Blood is warmed and infused using either a push-pull or isovolumetric method while carefully monitoring the infant. Potential complications include blood clots, changes in blood chemistry, heart/lung problems, and low risk of infection.

1. PREPARED BY
AASMAPOUDEL
ROLLNO01
BNS2ND YRS

2. Introduction
• This procedure was first experienced in
1970
• This procedure involve :
–Slowly removing person’s blood and
–Replacing it with fresh donor blood or
plasma.

3. Definition
• An exchange transfusion involves removing aliquots of patient
blood and replacing with donor blood in order to remove abnormal
blood components and circulating toxins while maintaining
adequate circulating blood volume.

4. Indication
• Hyperbilirubinea :
Serum bilirubin 5mg /dl at birth
Serum bilirubin is equal or more than 20 mg / dl ( term ) , 15
mg / dl ( preterm) at anytime in first week of life.
• Rhesus / ABO incompability
• Severe anemia
• Hydrops fetalis
• Other :
Hyperkalemia
DCI
Neonatal polycythemia
Drugs toxicity

5. Contraindication
• Unstable haemodynamic condition.

6. Methods of exchange transfusion
• Push pull method :
• Isovolumetric
method :

7. Exchange transfusion requirements
• To be conduct in NICU level .
• Staffing
• Blood
• Consent
• Monitoring equipment :
 Servo controlled rediaent warmer
 Cardio – respi monitor
 Pulse oximeter
•Infant resuctitation equipment
•Emergency medicine trolley .
Figure : Blood Product

8. Figure : Blood warmer

9. Contd…
• Patent preparation
 Nill per oral : 4 hrs prior to
procedure
 Empty stomach by NG tube
 Continue child monitoring
• Asepsis technique throughout
procedure.
• Monitor baby vital status, atleast 15
minutes interval.

10. Complications
• 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)

11. Nursing management