Two Catheter – Push-Pull – Set Up and Management

Step	Action
1	Use prepacked Exchange Transfusions two catheter push-pull set. See diagram below.
2	Place Astroflow unit on to pole on ponta, switch unit on and adjust setting to 39.5° C, then press start (confirms the change or unit will reset to default settings)
3	Prime the blood filter, Alaris giving set and one way valve with blood.
4	When ready to commence the exchange, connect the outline to baby’s arterial line.
5	Place the Alaris line in the warming sheath (from the roller clamp down) and connect to the baby's venous line.
6	The nurse assisting may manage one of the lines as directed by the Consultant/Registrar/NS-ANP. (If this happens another level 4 nurse must then be doing the recording of blood volumes)
7	The nurse is responsible for recording in and out blood volumes. Each cycle in and out should take approximately 4 minutes.
N.B.	The transfusion should not commence until nursing and medical staff agree that the circuit set up is correct.

Observe carefully throughout the procedure that there is no air in the line.

Two Catheter - Push-Pull - Diagram