Neonatal exchange transfusion sydney local health district. The exchange transfusion tray is a valuable tool in standardizing protocols for quality patient care. The length of the procedure varies from patient to patient, and depends on the amount of abnormal red blood cells that need to be exchanged. The guidance exchange transfusion must take place in an intensive care setting with intensive and physiological biochemical monitoring, carried out by staff that are trained in the procedure ideally following written informed parental consent. The request should be for o negative packed red blood cells of the specific volume needed and of the. An exchange transfusion involves removing aliquots of patient blood and replacing with donor blood in order to remove abnormal blood components and circulating toxins whilst maintaining adequate circulating blood volume. Double volume exchange transfusion is mainly used for the management of. Slowly the infants blood is withdrawn, and the fresh, prewarmed blood or plasma is injected. Albumin is a useful adjunct to exchange transfusion and increases. It is usually performed in the first 23 days of life. Among the elements transfused are packed red blood cells, plasma, platelets, granulocytes, and cryoprecipitate, a plasma protein rich in antihemophilic factor viii. Pdf once commonly performed in the nicu, double volume exchange transfusion has become a rare procedure due to the prevention of. This is a controlled document and therefore must not be changed cardiovascularly unstable, or becomes hypotensive during the venesection, the replacement transfusion should be started sooner, i.
Complications have been reported and mortality rates vary from 0. Exchange transfusion et procedure et is a procedure by which an infants blood is replaced with donor blood by repeatedly removing and replacing small aliquots of blood over a short time period. Double volume exchange transfusion american academy of. Apr 19, 2017 process of blood exchange transfusion for neonatal jaundice by umbilical catheter alshifa hospital nicu palestinegaza. Exchange transfusion is the treatment of choice for hyperbilirubinemia when the most aggressive intervention is necessary. The procedure involves the staged removal of the infants blood and replacement with fresh donor blood or plasma.
Anticipate the need for increased oxygen requirement during procedure administer oxygen via nasal cannula in self. If an exchange transfusion is necessary, compatible blood must be ordered. Continue until the total exchange volume is reached. The plasma concentrations of hb polytaur and hb polytaur n were 0. The amount of blood exchanged is expressed as multiples of the infants blood volume. Eg 3kg baby with a blood volume of 80mlkg blood volume is 240mls volume to be exchanged is 480mls rate 12mlkgmin so exchange rate is 6mlmin 4806 80 minutes to complete the double volume exchange. Feb 05, 2018 exchange transfusion preterm baby package. Thames valley haematology network adult haemoglobinopathy service. These are low cost, easy to assemble, authentic, and realistic task trainers that provide the opportunity for neonatal providers to practice this rare, lifesaving procedure. Jun 22, 2017 exchange transfusion is effective and considered to be safe procedure. For all neonates, we used fresh collected exchange transfusion should always be discussed with the sickle cell consultant or the haematology consultant oncall. Exchange transfusion definition of exchange transfusion by. A blood transfusion is a potentially hazardous procedure.
Exchange transfusion in the neonate starship hospital. If two catheters are in place, withdraw 5mlkg blood from the arterial catheter and infuse 5mlkg donor blood through venous catheter simultaneously. Rh negative blood is used because, even though the newborn may have rh positive blood, maternal antibodies that. A normal rbc exchange transfusion lasts about 12 hours. Jan 01, 2006 the preoperative transfusion sickle cell study group showed that for the most common surgical procedures, simple transfusion to a hb of 10 was equivalent to exchange transfusion for patients with sickle cell anemia in prevention of postsurgical complications vs. In these cases, exchange transfusion is a lifesaving procedure designed to counteract the effects of serious jaundice, infection, or toxicity. The patients blood is removed and replaced by donated blood or blood components. Exchange transfusion with a 3 per cent solution calculated on heme basis of hb polytaur and hb polytaur n was performed in mice to produce an approximate 20 per cent decrease in arterial hematocrit.
It is a cost effective, needleless system that maximizes the use of sterile connection and single donor exposure for the neonatal patient. An exchange transfusion is a sterile aseptic procedure and can be carried out using either of two techniques. Rarely there are other indications for exchange transfusion including volume overload. Transfusionists are referred to the aabb technical manual for applicable chapters on adult and pediatric transfusion3. Exchange transfusion is a procedure that is useful in the treatment of conditions such as very high levels of jaundice. Exchange transfusion should be performed slowly over approximately 2 hours to avoid major fluctuations in blood pressure. Use either one catheter or two catheter push pull set up. This lesson will discuss the nursing protocols and patient. Exchange transfusion is a manual procedure in which a patients blood is replaced with donors whole blood that has been resuspended to a specific hematocrit. Stringent procedures must be followed to ensure that the correct blood is given and that any adverse reactions are dealt with. Pdf neonatalexchangetransfusionnetwhatisitscurrent. In most cases optimizing phototherapy prevents the need for exchange transfusion. The current trend is to transfuse blood components rather than whole blood.
This technical report describes the creation of two exchange transfusion models in the newborn. Exchange blood transfusion an overview sciencedirect topics. To keep the infant comfortable during the procedure. Connect the circuit as shown in the diagram see appendix 2a2b2c overall rate of exchange transfusion is 12 mlkg min. Thames valley haematology network adult haemoglobinopathy. Benefit versus risk in otherwise well babies the risk of exchange transfusion are usually small but in preterm babies who are unwell the risks of exchange transfusion are increased and the procedure must be balanced the high. This procedure, used most commonly to treat severe unconjugated hyperbilirubinemia, removes the infants. Exchange transfusion an overview sciencedirect topics. Blood exchange transfusion for infants with severe neonatal hyperbilirubinemia an approach to the management of hyperbilirubinemia in the preterm infant less than 35 weeks of gestation if you have questions about any of the clinical pathways or about the process of creating a. A critical action checklist is included to guide the simulated procedure. Double volume exchange transfusion clinical pathway icu. Blood exchange transfusion for infants with severe neonatal hyperbilirubinemia an approach to the management of hyperbilirubinemia in the preterm infant less than 35 weeks of gestation if you have questions about any of the clinical pathways or about the process of creating a clinical pathway please contact us. Procedure techniques an exchange transfusion is a sterile aseptic procedure and can be carried out using either of two techniques.
The likelihood of an uncomplicated exchange is increased if care is taken to have good arterial and venous access, and to have all equipment checked and ready prior to commencing. Medical teams or itu teams may also perform ebts after discussion with the haematology team. Volpe, in volpes neurology of the newborn sixth edition, 2018. Exchange transfusion et in neonates is used to treat severe. The aim of exchange transfusion is to lower the hbs level to 30% or less while.
The procedure should be performed by a member of the haematology team consultant, spr, sho or cns. Exchange transfusion royal cornwall hospitals trust. The procedure is used to save the life of an adult or child with lifethreatening blood abnormalities. Consent for treatment is documented on a consent form agreement to treatment cr0111. This exchange transfusion can be performed manually or using a machine apheresis. Exchange transfusion in the treatment of neonatal septic.
After the exchange transfusion, an umbilical catheter may be left in place in case the procedure needs to be repeated within a few hours. Exchange transfusion definition of exchange transfusion. Neonatal exchange transfusion neonatal 5 partial volume exchange to lower hematocrit to lower hematocrit. Exchange transfusion if rate of rise in sbr is such that sbr is likely to reach 300 micromoll aim to keep sbr below 340 micromoll informed consent before the commencement of any blood or blood product infusion the medical officer or registered nurse administering the blood product must ensure that parents have given an informed consent for the procedure. Use of a surgical safety checklist is recommended by the world health organization. We hope that the compendium becomes an essential educational resource and reference guide for transfusion.
If exchange transfusion likely, discuss with parents. An exchange transfusion is a blood transfusion in which the patient s blood or components of it are exchanged with replaced by other blood or blood products. The performance of an exchange transfusion is not dissimilar to performing a surgical procedure. Indication for exchange transfusion in hyperbilirubinaemia. Exchange transfusion is a procedure performed within newborn services for the treatmentcorrection of anaemia, hyperbilirubinaemia, and to. Exchange transfusion must take place in an intensive care setting with intensive and physiological biochemical monitoring, carried out by staff that are trained in the procedure ideally following written informed parental consent. This leaflet will explain some details about the procedure. Your doctor will have explained to you why your baby needs an exchange transfusion. Complications of exchange transfusion in neonates full text. An exchange transfusion involves removing aliquots of patient blood and replacing. This exchange transfusion can be performed manually or using a machine. Exchange transfusion neonatal clinical guideline v1. An exchange transfusion reverses or counteracts the symptoms of jaundice or other blood diseases, such as sickle cell anemia.
The aim is to remove antibody coated red cells and excess bilirubin and increase haemoglobin hb. Most blood transfusions involve adding blood or blood products without removing. Process of blood exchange transfusion for neonatal jaundice by umbilical catheter alshifa hospital nicu palestinegaza. Red cell exchange in sickle cell disease hematology. The 60 ml syringe will need to be filled numerous times to complete the exchange transfusion. The likelihood of an uncomplicated exchange is increased if care is taken to have good arterial and venous access, and to have all. Complications of exchange transfusion in neonates full. This procedure is still to be treated as an exchange transfusion and must follow the same technique and procedure guidelines as a full exchange transfusion above.
Blood bank personnel will notify patient unit personnel by telephone when ordered blood is ready for transfu sion. Rbc exchange transfusion is a safe procedure, but side effects can occur. Also included is a suggested clinical scenario with. Mar 06, 2019 the exchange transfusion now goes ahead in cycles, each of a few minutes duration.
An exchange transfusion is a blood transfusion in which the patients blood or components of it are exchanged with replaced by other blood or blood products. To exchange all or part of an infants blood supply forcertain medical conditions is called exhangetransfusion. Blood exchange transfusion neonatal jaundice youtube. Oct 15, 2018 partial exchange transfusion procedure. This procedure, used most commonly to treat severe unconjugated hyperbilirubinemia, removes the infants circulating blood and replaces it with donor blood. Exchange transfusion is effective and considered to be safe procedure. Exchange the infants blood for normal saline, in increments not to exceed 5% of the estimated total blood volume. Similar decreases occurred after exchange transfusion of a 5 per cent albumin solution. The exchange transfusion now goes ahead in cycles, each of a few minutes duration. Exchange transfusion is a potentially life saving procedure that allows correction of anaemia.
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