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320 Section VIII ■ Transfusions

b. With symptoms or signs of hypocalcemia

(1) Change in QTc interval

(2) Agitation and tachycardia: These symptoms are

not reliably correlated with ionized calcium levels.

It is rarely necessary or advantageous to give

calcium during an ET if the infant is normocalcemic. When administered, the effect may last

only a few minutes. Calcium will reverse the

effect of the anticoagulant in the donor blood

and may cause clotting of the line, so administration through a peripheral IV line is preferred.

If calcium is given through the UVC, prior to

administration, clear the line of donor blood

with 0.9% NaCl. Give 1 mL of 10% calcium

gluconate per kilogram body weight. Administer

slowly, with careful observation of heart rate and

rhythm. Clear line again with 0.9% NaCl.

18. Perform calculated number of passes, until desired volume has been exchanged.

19. Be sure there is adequate volume of donor blood

remaining to infuse after last withdrawal, if a positive

intravascular balance is desired.

20. Clear umbilical line of banked blood and withdraw

amount of infant’s blood needed for laboratory testing,

including re-cross-matching.

21. Infuse IV fluids with 0.5 to 1 U heparin/mL of fluid

through UVC if further ETs are anticipated.

22. Total duration for double volume ET: 90 to 120 minutes.

23. Document procedure in patient’s hospital record.

Exchange Transfusion Using a Single

Umbilical Line and Two Three-Way

Stopcocks in Tandem

The principles and techniques for using either the special

stopcock or two three-way stopcocks in tandem are the

same. It is important to ensure that all junctions are tight to

produce a closed, sterile system. It is also essential to understand the working positions of the stopcocks before starting

the exchange.

1. Scrub as for major procedure. Wear sterile gown and

gloves.

2. Attach stopcock and tubing in sequence (Fig. 44.5).

a. Proximal stopcock

(1) Umbilical catheter

(2) IV extension tubing to sterile waste container

b. Distal stopcock

(1) Tubing from blood-warming coil

(2) 10- or 20-mL syringe

3. Clear lines of air bubbles.

4. Start exchange record.

5. Follow steps of push–pull technique until exchange is

completed.

Fig. 44.5. Three-way stopcocks in tandem. Step 1: Stopcocks positioned for withdrawing blood from

infant. Step 2: Stopcocks positioned for emptying withdrawn blood to waste container. Step 3: Stopcocks

positioned for filling syringe from blood bag. Step 4: Stopcocks positioned for injecting blood into infant line.

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