316 Section VIII ■ Transfusions
2. Resuscitation equipment and medication (immediately
6. Equipment for central and peripheral vascular access
7. Blood warmer and appropriate cartridge (see E7)
8. Sterile exchange transfusion equipment
a. Preassembled disposable set with special four-way
(1) Two three-way stopcocks with locking connections
(2) 5-, 10-, or 20-mL syringes
(3) Waste receptacle (empty IV bottle or bag)
10. Syringes and tubes for pre- and postexchange blood tests
1. Stabilize infant before initiating exchange procedure.
2. Do not start exchange procedure until personnel are
available for monitoring and as backup for other emergencies.
3. Monitor infant closely during and after procedure.
a. May necessitate repeat if efficacy is decreased by
b. Stop or slow if patient becomes unstable.
5. Use blood product appropriate to clinical indication.
Use freshest blood available, preferably <5 to 7 days.
6. Check potassium level of donor blood if patient has
hyperkalemia or renal compromise.
7. Use only thermostatically controlled blood-warming
device that has passed quality control for temperature
8. Do not apply excessive suction if it becomes difficult to
draw blood from line. Reposition line or replace
syringes, stopcocks, and any adapters connected to line.
9. Leave anticoagulated, banked blood in line or clear
line with heparinized saline if the procedure is interrupted.
10. Clear line with heparinized saline if administering calcium.
F. Preparation for Total or Partial
(1) Plasma reduced whole blood or packed red cells
reconstituted with plasma may be used (23).
Fig. 44.1. Guidelines for exchange transfusion
in infants 35 or more weeks gestation. (From
American Academy of Pediatrics. Subcommittee on Hyperbiliru-binemia. Clinical
Practice Guideline. Management of hyperbilirubinemia in the newborn infant 35 or more
weeks gestation. Pediatrics. 2004;114:297.)
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