what is your criteria for exchange transfusions?

[eph432girl]

I work in reference and transfusion services (blood bank) - will start nursing school in Spring 05. I have some questions for the NICU nurses about exchange transfusions.

What criteria does your neonatologist use to decide to transfuse? Specifically, we had a 5day old baby come in OP today for bilis. Total was 18. Baby was admitted and repeated at 20.5 (venous sample - not hemolyzed). Dr ordered a DAT only, but I had collector go band baby since we had enough to do T&S/XM. Baby is on phototherapy and I will see in the morning when I go in if we get TS/crossmatch order (or at least a phone call asking for a fresh unit if they decide to transfuse).

Our hospital has recently expanded our NICU and we have started doing some baby transfusions (mainly to replace blood volume). They have threatened a few exchange transfusions, but it has never happened.

Also, what is involved when you (as the nurse) do the exchange? Drs have asked us in the blood bank that we make a modified 600ml whole blood product (meaning an O= packed cell unit which is CMV=, Leukopoor, irradiated, and less than 4 days old .....mixed with equal volume of FFP). As far as the blood bank part of the procedure is concerned, once we create an "open system", we are supposed to give it an outdate of 4 hours. How do you transfuse it? Do you transfuse aliquots of 50cc at a time or what?

Thanks for any info, tips, tricks!

Christine BS(MT), MT(ASCP) -- for a few more months anyway :chuckle

[Gompers, BSN, RN]

Different hospitals seem to have different policies and procedures for exchange transfusions. In my NICU, the bilirubin light level and exchange level changes every few days. The numbers depend on how many days old the baby is and what the current gestational age is. The docs use some sort of table that has all the info for them. So there is no one magical number for exchange transfusion.

We rarely do them, maybe 2-3 times a year, and we have a large level III NICU. It's almost always an ABO/RH incompatibility issue that cannot be avoided. The rest of the babies respond very well to increased fluids and double or triple phototherapy lights.

If I remember correctly, we do the transfusion in 10cc aliquots, but I think it depends on the baby's size as well. We don't hang the transfusion over a length of time, either. Blood is drawn out of the baby and then an equal amount is transfused by slow IV push. The docs put in a UVC line and then they are the ones who actually remove and transfuse blood from it. The nurse monitors the baby's vitals and records everything on a special exchange transfusion sheet. Usually takes about 2 hours. Like I said, it's pretty rare for us so forgive me if I'm not on the ball!