The document outlines the procedure for exchange transfusion (ET) in neonates, detailing its historical background, definitions, indications, necessary preparations, equipment, and procedural steps. It emphasizes the management of hemolytic disease of the newborn and associated complications while highlighting safety measures during the procedure, including monitoring and post-exchange care. Additionally, it includes information on potential complications and responsibilities of the healthcare team throughout the process.

1. ASSIST IN EXCHANGE TRANSFUSION

2. Introduction
• In 1923, Dr. James Sidbury, administered blood through the
umbilical vein to treat HDN
• First ET (aka exsanguination, venesection or substitution
transfusion) was reported by Dr. A.P Hart in 1925

3. Definition
• Repetitive withdrawal of small amounts of blood and replacement
with donor blood, until a large portion of the original volume has
been replaced
• Blood volume in neonates: 75 to 105 ml/kg

4. Indication of ET
• When phototherapy fails to prevent rise in bilirubin level
• Hemolytic disease of newborn (HDN)
- ABO Incompatibility
- Rh Incompatibility
• Severe sepsis
• Severe anemia causing cardiac failure
• Poisoning

5. Hemolytic Disease of the Newborn
• It is a blood disorder in neonates, when the red blood cells
break down at a fast rate.
•
• It is also called Erythroblastosis Fetalis
• Caused mainly due to incompatibility between the blood
types of mother and baby.
• Complications: Severe hyperbilirubinemia, jaundice and
kernicterus

6. Things to do before exchange
• Admit baby to NICU
• Immediately start phototherapy
• Send blood to assess the total bilirubin and blood grouping
• Stop feed and start IV fluid to hydrate the baby.
• Put in NG tube on drainage.
• Explain treatment and obtain written consent from the parents

7. CONT…
•Request for whole blood from blood bank which is
irradiated.
•Irradiated blood must be used within 24 hours

8. Equipment required
• Radiant warmer
• Respiratory support : Ventilators, ET tube, AMBU bag etc.
• Suction equipment
• Multi-Channel Monitor: Heart rate, RR and SpO2
• Umbilical catheterization set
• NG tube and umbilical catheter
• Disposable syringes: 20cc, 10cc, 5cc, 2cc
• Three way stopcock connector x 2 nos
• Sterile gloves
• I/V tubings
• Waste recipticle

9. Steps of procedure
1. Umbilical Vein Catheterization

10. 2. Exchange of blood
PUSH- PULL METHOD

12. Volume of blood for double volume ET
Volume of blood = Weight (Kg) x 2 x 80
- Add additional 20 to 30 mL for dead space in tubing

14. Aliquot Size
Weight (grams) Aliquot Size
<1500 5 ml
1500 – 2500 10 ml
2500 – 3500 15 ml
> 3500 20 ml

15. Responsibilities
• A temperature controlled device must be used for warming blood before and
during the transfusion
• Record time, vital signs, amount of blood out and in after each cycle
• The blood should be mixed after every exchange to prevent settling of RBCs.
(Procedure takes at least 1 hour)
• Continue phototherapy after ET
• Antibiotic prophylaxis may be considered

16. Post Exchange Investigations
• S. Bilirubin
• S. Electrolytes
• S. Calcium
• RBS
• CBC

17. COMPLICATIONS
Complication related to catheter
• False passage
• Hematoma
• Hemorrhage from umbilical vessel
• Thrombosis
• Infection

18. Complication related to exchange
• Hypothermia
• Cardiac dysrhythmia, arrest, failure
• Electrolyte imbalances
• Hyperglycemia or Hypoglycemia
• Coagulopathies
Chronic complications:
• Anemia
• Portal vein thrombosis
• GVHD

19. Link for YouTube video
https://www.youtube.com/watch?v=42xzmYqkjB4

20. THANK YOU
Astt. Prof. Livson Thomas
College of Nursing
Christian Hospital
Bissamcuttack, Rayagada
Odisha