Paediatric Nursing (PAED)
EXCHANGE BLOOD TRANSFUSION IN A NEWBORN
Replacement of infant's blood with donor blood to treat severe hyperbilirubinemia or other conditions.
Purpose
- Remove bilirubin
- Remove antibodies
- Correct severe anemia
- Treat hemolytic disease
Indications
- Severe hyperbilirubinemia
- Hemolytic disease of newborn
- Severe anemia
- Polycythemia
Equipment
- Fresh compatible blood
- Umbilical venous catheter
- Syringes
- Three-way stopcock
- Monitoring equipment
- Calcium gluconate
- Emergency equipment
Preparation
- Obtain consent
- Prepare NICU environment
- Assemble team
- Calculate exchange volume
Procedure steps
- Verify order and consent
- Prepare blood products
- Establish UVC access
- Withdraw blood slowly
- Infuse donor blood
- Monitor continuously
- Calculate volumes
- Document procedure
Precautions
- Monitor calcium levels
- Watch for arrhythmias
- Maintain temperature
- Use strict asepsis
Aftercare
- Monitor bilirubin levels
- Assess for complications
- Continue phototherapy if needed
- Document outcome
Nursing considerations
- Maintain thermoregulation
- Monitor glucose
- Watch for citrate toxicity
Patient education
- Explain procedure to parents
- Discuss rationale
- Provide emotional support
Documentation
- Volumes exchanged
- Vital signs
- Complications
- Pre/post bilirubin levels
References and further reading
Educational resource only. Follow current Nursing and Midwifery Council guidance, local institutional protocols, scope of practice, and clinical supervision.
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