Paediatric Nursing (PAED)
MANAGEMENT OF A BABY DURING EXCHANGE BLOOD TRANSFUSION
This is the procedure of removing baby's blood and replacing it with donor blood, typically for severe hyperbilirubinemia.
Purpose
- Remove bilirubin
- Remove antibodies
- Correct anemia
- Prevent kernicterus
Indications
- Severe hyperbilirubinemia
- Hemolytic disease of newborn
- Failed phototherapy
Equipment
- Umbilical venous catheter
- Fresh compatible blood (warmed)
- Syringes and three-way tap
- Heparinized saline
- Resuscitation equipment
- Monitoring equipment
- Calcium gluconate
- Glucose
Preparation
- Calculate blood volume needed
- Warm blood to body temperature
- Prepare resuscitation equipment
- Assign team roles
Procedure steps
- Verify order and obtain consent
- Prepare warmed blood
- Insert umbilical venous catheter
- Connect three-way system
- Withdraw blood slowly (5-10ml aliquots)
- Inject donor blood slowly
- Monitor vital signs continuously
- Alternate withdrawal and infusion
- Record volumes accurately
- Monitor glucose and calcium
- Complete exchange (typically 2x blood volume)
- Remove catheter or secure for further use
Precautions
- Maintain strict asepsis
- Warm blood appropriately
- Monitor for complications
- Work slowly and carefully
Aftercare
- Monitor bilirubin levels
- Watch for rebound hyperbilirubinemia
- Continue phototherapy if needed
- Monitor for complications
Nursing considerations
- Maintain thermoregulation
- Monitor glucose closely
- Watch for apnea/bradycardia
Patient education
- Explain procedure to parents
- Discuss rationale
- Address concerns
- Provide emotional support
Documentation
- Pre and post bilirubin levels
- Blood type and volume used
- Volumes withdrawn and replaced
- Complications encountered
- Vital signs throughout
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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