2. One Catheter Push-pull Technique

This can be done through an umbilical venous catheter. ³ Exceptionally, an umbilical artery catheter can be used.
Ideally, the tip of the UVC should be in the IVC/right atrium (at or just above the diaphragm) but can be used if it is in the portal sinus. For ‘high’ UVC placement, position should be checked by an X-ray. This is not always necessary for a low position. A low positioned catheter is usually removed after each exchange.
Withdraw blood over 2 minutes, infuse slightly faster.

Volume

Usually use two blood volumes (180 ml/kg).
- One blood volume removes 65% of baby’s red cells.
- Two blood volumes removes 88%.
Thereafter the gain is small.³

There must be at least one doctor/NS-ANP and one nurse exclusively involved in the exchange throughout its progress.
Meticulous care must be taken throughout, especially with volume balance, the rate of the exchange, the vital signs and any signs of air in the lines.
A doctor/NS-ANP must be present throughout the exchange. He/she may leave the room briefly to get blood results, but if called away, the exchange is stopped and the lines flushed.
All exchanges are to be conducted in NICU Level 3.
It may be necessary for another doctor/NS-ANP to cover the rest of the unit during the exchange.
IF THERE ARE ANY DOUBTS ABOUT THE SET-UP OR THE METHOD OF DOING THE EXCHANGE TRANSFUSION, THEY MUST BE IMMEDIATELY REFERRED TO SENIOR MEDICAL OR NURSING STAFF AND THE EXCHANGE INTERRUPTED UNTIL THEY ARE ANSWERED SATISFACTORILY.

Polycythaemia

Volume exchanged (ml) =	Blood Volume x (PCV initial - PCV desired)
	PCV initial

Anaemia

Volume exchanged (ml) =	Blood Volume (ml) x (Hb desired - Hb initial)
	(Hb Donor - Hb Initial)

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1	Fok TF. So LY. Leung KW. Wong W. Feng CS. Tsang SS. Use of peripheral vessels for exchange transfusion. Arch Dis Child. 1990 65(7 Spec No):676-8
2	Martin JR. A double catheter technique for exchange transfusion in the newborn infant. NZMJ 1973; 77(490):167-9
3	Edwards. chapter 41 in Atlas of procedures in neonatology. 2^nd ed. Lippincott. 1993
4	Ramirez AM. Woodfield DG. Scott R. McLachlan J. High potassium levels in stored irradiated blood. Transfusion 1987; 27(5):444-5
5	Ramirez. Unpublished. Potassium in blood for exchange transfusion. 1986.
6	Schuerger G. Robertson A. Ertel I. Effects of agitation of donor blood on neonatal exchange transfusions. Clinical Pediatrics 1970; 9(12):715-8
7	Peterec SM. Management of Neonatal Rh Disease. Clinics in Perinatology 1995;22:561-92

Technique	Procedure	Partial Exchange Transfusion
Other Related Documents		References