Monitor cardiorespiratory status, continuous pulse
oximetry. Determine blood gases as often as indicated
by pre-existing clinical condition and stability.
11. Draw blood for diagnostic studies.
12. Usual rate of removal and replacement of blood during
the ET is 5 mL/kg over a 2- to 4-minute cycle.
13. If infant is hypovolemic or has low CVP, start exchange
with transfusion of aliquot into catheter. If infant is
hypervolemic or has high CVP, start by withdrawing
14. Remeasure CVP if indicated. Expect rise as plasma
oncotic pressure increases, if CVP low at start.
15. Ensure that the stages of drawing and infusing blood
from and into the infant are done slowly, taking at
least a minute each to avoid fluctuations in blood
pressure. Rapid fluctuations in arterial pressure in the
push–pull technique may be accompanied by
changes in intracranial pressure (28). Rapid withdrawal from the umbilical vein induces a negative
pressure that may be transmitted to the mesenteric
veins and contribute to the high incidence of ischemic
16. Gently agitate the blood bag every 10 to 15 minutes to
prevent red cell sedimentation, which may lead to
exchange with relatively anemic blood toward the end
17. Consider giving calcium supplement.
a. When hypocalcemia is documented
Fig. 44.3. Special four-way stopcock. A: Male adapter to infant
line. B: Female adapter to waste container. C: Attachment to
blood tubing. D: “Off” position (180 degrees from adapter to waste
container), allowing injection through rubber-stoppered port
“below” syringe. The stopcock is used in clockwise rotation when
Fig. 44.4. A, B: ET using special four-way stopcock.
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