320 Section VIII ■ Transfusions
b. With symptoms or signs of hypocalcemia
(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,
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
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
1. Scrub as for major procedure. Wear sterile gown and
2. Attach stopcock and tubing in sequence (Fig. 44.5).
(2) IV extension tubing to sterile waste container
(1) Tubing from blood-warming coil
3. Clear lines of air bubbles.
5. Follow steps of push–pull technique until exchange is
Fig. 44.5. Three-way stopcocks in tandem. Step 1: Stopcocks positioned for withdrawing blood from
Comments
Post a Comment
اكتب تعليق حول الموضوع