This is the nursing care given to a baby undergoing exchange blood transfusion. It is a procedure whereby a nurse assists the paediatrician to remove and replace majority of baby’s circulating blood with a donated screened fresh blood or plasma while maintaining adequate circulating blood volume.
Aims
· Reduce serum bilirubin levels and reduce the risk of brain damage
· Remove circulating maternal antibodies destroying the baby’s red blood cells
· Prevent an acute splenic sequestration in a baby with sickle cell disease
Requirements
1. A trolley containing the following:
a. Top shelf:
· Intravenous infusion (0.9 % Normal Saline)
· Sterile gloves
· Examination gloves
· Gallipot
· Receiver for soiled swabs
· Hydrocortisone
· Adrenalin
· Calcium Gluconate 10%
· Sodium Bicarbonate 8.4%
· 10% Dextrose
· Frusemide
· Syringes (2cc, 5cc and 10cc)
· Nasal prongs/face mask
· Intravenous cannula
· Specimen sample bottles
· 3-way tap
b. Bottom shelf
· Vital signs tray
· Gallipot with cotton wool swabs
· Savlon solution
· Methylated spirit
· Thermometer
· Pulse oximeter
· Pain scale (appropriate)
· Sphygmomanometer (manual/electronic)
· Glucometer with strips
· Suturing scissors
· Dressing pack
· Forceps (dressing, curved mosquito, straight mosquito
· Sutures
· Self-inflating bag and mask
· Cord ligature
· Drapes
2. Suction machine Oxygen source
3. Drainage bag
4. Cross splint and pad
5. Blanket or extra sheet
6. Blood bank issue slip
7. Intake and output chart
8. Screened blood in a warmer
9. Cannulae
10. Thermometer
11. Drip Stand
12. Plain Giving set
13. Glucometer with strips
14. Adhesive Plaster
15. Exchange blood transfusion form
16. Plastic aprons or protective gown
17. Patient chart: vital signs chart, nurses notes and treatment chart
Steps
1. Establish rapport (refer steps)
2. Explain procedure to child or caregiver/family (refer steps)
3. Allow caregiver to take a decision of either staying or leaving the resuscitation area
4. Provide privacy
5. Get informed consent from the parents
6. Ensure nil per os 4 hours before the procedure starts
7. Aspirate previous feeds if baby has been fed 4 hours before procedure
8. Perform hand hygiene
9. Provide warmth by placing baby in an incubator or radiant warmer
10. Check the blood type against the neonate’s blood before administering
11. Expose and immobilize the baby on cross splint
12. Check vital signs before the procedure and hourly throughout the procedure
13. Check random blood sugar before and after the procedure
14. Administer a bolus of 10% dextrose (4ml /kg) if random blood sugar is low
15. Open dressing pack and assist in cleaning of umbilical stump and drape the sterile linen
16. Assist the Paediatrician to take pre exchanged blood sample
17. Assist Pediatrician throughout the procedure
18. Administer 1-2ml of 10% calcium gluconate after 100-200ml of blood has been exchanged (if prescribed)
19. Monitor for adverse effect
20. Document time of starting the procedure, time of completion, amount and type of blood exchanged, condition of baby during and after procedure in patient’s chart
21. Take the last aliquot of blood removed for post transfusion analysis (Hb, serum bilirubin, serum electrolytes etc)
22. Start phototherapy whiles awaiting serum bilirubin level results
23. Notify the Ward Manager, Paediatrician/Doctor-in-charge of any post adverse reactions
24. Dispose off and decontaminate used items
25. Appreciate mother and child
26. Record all procedures in patient’s chart
0 Comments