D. Albumin 25% 3 yr at room temperature

1. Requires no crossmatch

2. Increases plasma

oncotic pressure

with low volume

1. Expense

2. Does not provide

coagulation factors

3. Can produce pulmonary edema, and

cardiac failure

1. Five micron filter

required

2. Na 130–160

3. Osmolarity 1,500

MOs m/L

(continued )

414 Appendix C

Plasma Products

Products Volume (mL) Shelf Life Advantages Disadvantages Comments

E. Plasma frozen

within 24 h (F24)

180–300 1 yr if frozen;

1–5 d postthawing

1. Contains plasma

proteins, coagulation factors, anticoagulant proteins,

complement, and

albumin

1. May be less effective

for FV, FVIII, and

VWF replacement

2. Not indicated for

volume expansion/

fibrinogen replacement

1. Separated from WB

and frozen with 24 h

2. Most commonly

available from blood

suppliers

F. Single source

plasma

180–300 1. Contains plasma

proteins, coagulation factors, anticoagulant proteins,

complement, and

albumin

1. From single-donor

plasmapheresis

2. Can be aliquoted

into small volumes

and frozen for neonatal use

G. Recovered plasma 180–300 1. Contains plasma

proteins, coagulation factors, anticoagulant proteins,

complement, and

albumin

1. May be less effective

for FV, FVIII, and

VWF replacement

2. Not indicated for

volume expansion/

fibrinogen replacement

1. Plasma recovered

from WB without

specialized time

limit.

2. Quality of factors/

anticoagulant proteins not well studied

Table C.1 Blood Products (Continued)

415

E1ective Change of Orotracheal

Tube in Intubated Patient

This procedure allows continued ventilation through a preestablished airway whenever it is necessary to change an

endotracheal (ET) tube or to place a nasotracheal tube. By

maintaining the original airway as long as possible during

the change, there is less need for haste and less stress to the

patient. An obvious prerequisite is that the original ET tube

be patent and correctly positioned in the trachea.

Rapid Replacement Method

1. Prepare equipment and patient as for initial orotracheal

intubation.

2. Release tube fixation device without displacing tube.

3. Have assistant hold first ET tube in place at far left of

the infant’s mouth while continuing to ventilate infant.

4. Visualize glottis with laryngoscope.

5. Pass second orotracheal tube down far right of the

mouth until it aligns with glottic opening.

6. When new tube is positioned for direct insertion, have

assistant withdraw first tube carefully.

7. Advance new tube into position.

8. Verify position and secure tube as previously described.

Alternative Method: Insertion

over a Feeding Tube

Because of the narrow diameter of ET tubes in small infants,

feeding tubes narrow enough to fit inside the ET lumen are

often too flexible to stay within the trachea as the tubes are

being changed. Be prepared to intubate directly should the

feeding tube dislodge.

1. Prepare equipment and patient as for initial orotracheal

intubation.

2. Release tube fixation device without displacing tube.

3. Select the largest feeding tube that will easily go

through the current and new endotracheal tubes.

Remove the flared end of feeding tube and the adaptor

on the new tube.

4. Remove adaptor of currently in-place ET tube.

5. Quickly insert the feeding tube through the lumen to a

depth not greater than the ET tube.

6. While holding feeding tube in place, pull ET tube out

of trachea and off feeding tube.

7. Slide new ET tube over feeding tube into trachea.

8. Replace tube adaptor.

9. Verify position and secure tube as previously described.

Selective Left Endobronchial Intubation

The angles of the bronchi are such that more often than not

a tube will seek the right mainstem bronchus. The exceptions will be conditions that push the left side down (left

upper-lobe emphysema) or that pull the right side up

(marked upper-lobe atelectasis or hypoplasia). Normally,

successful right mainstem intubation simply requires a longer tube. Selective intubation of the left bronchus is a more

difficult and dangerous procedure; therefore, following all

precautions is especially important.

Place the ET tube under guidance by direct bronchoscopy or under fluoroscopy when these procedures are available without compromise to infants (1,2).

The following procedure is a simple, indirect method

based on a modification that tends to make the ET tube bend

toward the left when it meets resistance at the carina (3).

1. Cut an elliptical hole through half the diameter of ET

tube 1 cm in length and 0.5 cm above the tip of the

oblique distal end.

2. Perform an orotracheal intubation as above, keeping

the cut hole directed toward the left lung.

3. Turn infant’s head toward the right (4).

4. While auscultating the lung fields, advance the tube to

0.5 to 1 cm below the calculated depth of the carina or

until differential breath sounds are heard.

5. If breath sounds diminish on the left, withdraw the ET

tube until they return.

6. Take a chest radiograph to confirm left bronchial position.

7. Fix tube securely.

8. Reassess position frequently, as tube may dislodge from

one mainstem into the other.

9. Follow patient closely for particular complications of

a. Air leak of ventilated area

b. Stasis pneumonia of nonventilated area

Appendix D

Chapter 36