a. Verify identification of blood product (see Chapter

43).

(1) Type and cross-match data

(2) Expiration date

(3) Donor and recipient identities

b. Attach blood administration set to blood-warmer

tubing and to blood bag.

c. Allow blood to run through blood warmer.

G. Technique (See also Website for

Procedure Video)

Exchange Transfusion by Push–Pull

Technique through Special Stopcock with

Preassembled Tray

1. Read instructions provided by manufacturer carefully.

2. Wear head cover and mask. Scrub as for major procedure. Wear sterile gown and gloves.

3. Open preassembled equipment tray, using aseptic technique.

4. Identify positions on special stopcock in clockwise rotation (Figs. 44.3 and 44.4). The direction that the handle is pointing indicates the port that is open to syringe.

The special stopcock allows clockwise rotation in the

order used: (a) withdraw from patient, (b) clear to waste

bag, (c) draw new blood, (d) inject into patient. Always

rotate in clockwise direction to follow proper sequence,

and keep connections tight.

a. Male adapter to umbilical or peripheral line

b. Female adapter to the extension tubing to which

waste bag will be attached.

c. Connection to tubing for attachment to bloodwarmer coil

d. Neutral “off” position in which additives may be

administered through rubber stopper (180 degrees

from waste-receptacle port)

5. Follow steps as illustrated by manufacturer to make all

connections to blood and waste bags.

6. With stopcock open to blood source, clear all air into

syringe. Turn in clockwise direction 270 degrees and

evacuate into waste.

Chapter 44 ■ Exchange Transfusions 319

7. Turn stopcock to “off,” and replace onto sterile field.

8. Use pre-existing umbilical venous line or insert UVC,

as described in Chapter 30.

a. Place a single-lumen UVC whenever possible. The

internal lumen of a double-lumen UVC is smaller

and makes it more difficult to perform the ET.

b. Consider central venous pressure (CVP) measurement, using pressure transducer, in unstable baby.

c. Place catheter in inferior vena cava (IVC) and verify

position by radiograph.

d. If catheter cannot be positioned in IVC, it may still

be used cautiously in an emergency, when placed in

the umbilical vein, if adequate blood return is

obtained.

9. Have an assistant document all vital signs, in and out

volumes, and other data, on the exchange record.

10. Check peripheral glucose levels every 30 to 60 minutes.