Complications

During Exchange

Air embolus

• Ensure the lines are correctly set up.
• Watch the lines constantly for air.  Be ready to turn off a line instantly if air is seen.
• Never have a 3 way tap open to air and the baby, especially on the venous side.
• Be very careful if there are large swings in intrathoracic pressure.

Volume imbalance

• The nurse is responsible for recording the volume balance throughout the exchange.

Arrhythmias

• Can occur from a variety of causes.
• Watch the ECG screen frequently and set up a monitor to have a beep with the QRS.

Acidosis

• Blood is preserved in CPD (citrate, phosphate, dextrose) and can be quite acidotic.
• Check the baby’s blood pH before, at least once during the exchange, usually half way, (more frequently for a sick, unstable or small baby) and after.

Respiratory distress

• Monitor respiration and SpO₂ constantly.

Unexpected collapse

• Be aware of this possibility.
• Watch the baby carefully. Have resuscitation equipment ready.
• In the event of a collapse during an exchange transfusion, click here.

Hyperkalaemia

• CPD blood can have high potassium [K⁺] levels.
• Check [K⁺] at the start of each bag.
• Monitor the QRS complex.
• Look at the [K⁺] with each blood gas.

Anaemia/Polycythaemia

• Check the PCV of each blood bag.
• Agitate the bag every 15 minutes.

Fluctuating BP and cerebral blood flow

• Especially in small or sick babies. Monitor rate of blood in and out carefully

After Exchange

Infection

• Prophylactic antibiotics are not indicated, but vigilance after the exchange is.

Hypocalcaemia

• May occur post exchange. Monitor [Ca⁺⁺] and give replacement Ca⁺⁺ in IV as per clinical guidelines

Hypoglycaemia

• Unlikely during the exchange as CPD blood has 19mmol/L [glucose].
• However rebound hypoglycaemia may occur afterwards.
• Commence a 10% dextrose infusion post exchange, or if the exchange is interrupted.

Hypernatraemia

• CPD blood has a high [Na⁺]. Monitor [Na⁺] with each gas.

Thrombocytopenia

• Very common, and more severe after more exchanges.
• Recovers in a few days.
• Monitor platelets serially for a week post exchange.

Polycythaemia or anaemia

• From poorly mixed or packed blood.

Coagulopathy or neutropenia

• More likely the more transfusions are done.

Necrotising enterocolitis

• Umbilical catheter related (especially with a low UVC) and maybe due to BP and blood volume fluctuations.
• Care with feeding post exchange.

Blood transmitted infections

• For a detailed list refer to Administration of Blood & Blood Products

Graft Versus Host Disease

• There have been several case reports.
• It seems to be more likely with more preterm infants, intrauterine transfusions, multiple exchanges, and related donors.
• Irradiate the donor blood.