|Reviewed by Clinical Practice Committee|
|Umbilical vein||Peripheral artery|
|or||Umbilical vein||Umbilical artery|
|or||Peripheral vein||Peripheral artery2|
|or||Peripheral vein||Umbilical artery|
N.B: Blood Volume = 70-90 ml/kg for term and 85-110 ml/kg for preterm infants
|<1000gms||Use 5ml aliquots|
All exchanges are to be conducted in NICU level 3
There must be at least one doctor/NS-ANP and one nurse exclusively involved in the exchange throughout its progress.
The nurse must be a level four nurse (or senior nurse), who is trained and up to date with this procedure.
The doctor/NS-ANP must be present throughout the exchange. If called away, the exchange is to be stopped and the lines flushed with NaCl 0.9%.
Meticulous care must be taken with volume balance, the rate of the exchange, the vital signs and any signs of air in the lines.
IF THERE ARE ANY DOUBTS ABOUT THE SET-UP OR THE METHOD OF DOING THE EXCHANGE TRANSFUSION, THEY MUST BE IMMEDIATELY REFERRED TO SENIOR MEDICAL OR NURSING STAFF AND THE EXCHANGE INTERRUPTED UNTIL THEY ARE ANSWERED SATISFACTORILY.
Asepsis must be maintained throughout the procedure.
|1||Thayyil S, Milligan D. Single versus double volume exchange transfusion in jaundiced newborn infants. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD004592. DOI: 10.1002/14651858.CD004592.pub2|
|2||Chen HN, Lee ML, Tsao LY. Exchange transfusion using peripheral vessels is safe and effective in newborn infants. Pediatrics. 2008 Oct;122(4):e905-10.|
|3||Iowa_Neonatology_Fellows. Exchange Transfusion. In: Bell EF, Segar JL, editors. Iowa Neonatology Handbook. Iowa City, Iowa: http://www.uihealthcare.com/depts/med/pediatrics/iowaneonatologyhandbook/procedures/exchangetransfusion.html; 2008.|
|4||Benders MJ, Meinesz JH, Dorrepaal CA, Steendijk P, van Bel F, van de Bor M. Effect of exchange transfusion on brain perfusion and electrocortical brain activity in newborn lambs. Biol Neonate. 1999;75(2):130-6.|
|5||Robitaille N, Nuyt A-M, Panagopoulos A, Hume HA. Exchange Transfusion in the Infant. In: Hillyer CD, Strauss RG, Luban NLC, editors. Handbook of Pediatric Transfusion Medicine. San Diego, California: Elsevier Academic Press; 2004. p. 159-66.|