1. ORIENTATION: 2005
Exchange Transfusion

2. Exchange Transfusion
Exchange transfusion is indicated with the presence of hemolytic disease when bili rubin levels meet those associated with Kernicterus despite use of photo therapy.
Exchange transfusion may be necessary to protect the CNS status of the jaundiced infant.
Most exchanges are done for ABO blood group incompatibility problems.

3. Exchange Transfusion Double volume Exchange Transfusion
Purpose-to remove the infant’s bilirubin and antibody-coated red blood cells from circulation by removing the infant’s blood volume and replacing the volume with blood or another volume expander

4. Partial Exchange Transfusions
Goals
Relieves congestive failure and helps improve CNS function
Corrects hypoglycemia
Reduces cyanosis
Improve renal function
Desired decrease in HCT less than 60%

5. Exchange Transfusion
Indications for double volume exchange transfusion
Bili level
Greater than mg/dl in an uncompromised term infant
Greater than 18 mg/dl in a high-risk term infant
10 to 18 mg/dl in the preterm infant depending on gestational age and conditions
10 to 12 mg/dl in a preterm or stressed infant when acidosis and/or hypoxia is present
Diagnosis and condition
How quickly level is rising
Gestational age
Actual age (in hours and days)
Presence of significant hemolytic disease
Increase in bilirubin despite phototherapy

6. Exchange Transfusion Nursing Care and Procedure Infant should be NPO
UVC and UAC/peripheral a-line placement; central or peripheral venous access can be used
Treatment of hypoglycemia, acidosis, temperature control, fluid and electrolyte imbalances prior to exchange transfusion
Administration of albumin for low albumin levels before and during exchange if needed; is contraindicated with severe anemia, hydrops, and CHF

7. Exchange Transfusion Nursing Care and Procedure-(continued)
HR/RR monitor, frequent B/P’s, place infant under RW; take vital signs and B/P before and after procedure; monitor vital signs q 5 minutes and prn during procedure
Have oxygen and suction available
Remember the A, B, C’s
Maintain sterility
Pre-exchange vital signs-TPR & B/P for baseline vital signs
Extra line of access for emergencies

8. Exchange Transfusion Pre-exchange labs on infant Type and cross Renal
Bili levels (conjugated and unconjugated)
Calcium
Glucose
CBC with diff
Coombs test
Possibly blood cultures
Blood gas

9. Exchange Transfusion Blood to be transfused should also be tested for
CBC
Bilirubin
Calcium
Physician and/or nurse practitioner must discuss plans of care concerning exchange transfusions and must obtain informed consent from parent or guardian
CAN DO (emergency code sheet) sheet must have current weight (dry or actual)
3 rounds of emergency medications at bedside, including 10% calcium gluconate

10. Exchange Transfusion Equipment needed Blood Warmer, preheated to
degrees Celsius
Blood Administration Sets
Blood Warming Coils
Multiple syringes
Stopcocks
Exchange Transfusion
Tray, if available

11. Exchange Transfusion Nursing Care
Assist physician/practitioner with procedure
Keep accurate tally of blood withdrawn and fluids infused
Assess infant for
Adverse or anaphylactic blood transfusion reactions
S/S of congestive heart failure, fluid depletion or overload, respiratory distress, and cardiac deterioration or arrest
S/S of hypocalcemia
Signs of complications
Adjust med schedules, especially meds that must maintained at certain drug levels; check drug levels
Keep parents updated of any significant events during exchange

12. Exchange Transfusion Post-exchange Resume phototherapy if needed
Vital signs-q 15 minutes X 2, then q 30 minutes X 2,
Monitor temperature closely for the next 24 hours
Obtain labs within one hour of exchange, with f/u bili levels every 4 hours until stabilized
Keep parents updated; encourage family interaction as infant tolerates
Maintain adequate hydration
Assess need for repeated exchanges