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Double Volume Exchange Transfusion Clinical Pathway, ICU – Risks, Complications, Troubleshooting

Double Volume Exchange Transfusion Clinical Pathway — ICU

Risks, Complications, Troubleshooting

Risks
  • Electrolyte imbalances (hypocalcemia, hyperkalemia)
  • Dysrhythmias
  • Coagulopathy/thrombosis
  • Infections
  • Possible contributor to NEC
  • IV infiltrate
  • Hypotension
  • Air embolism
Potential Complications
  • Signs suggesting an infant is not tolerating the procedure
    • Metabolic acidosis
    • Hypotension
    • Dysrhythmias
  • If not tolerating the procedure
    • Consider decreasing the volume removed with each pass from 3 mL/kg/min to a lower rate (e.g., 1 mL/kg/min)
    • Check for and correct identified electrolyte abnormalities
    • Ensure lines remain in appropriate position
Troubleshooting When Arterial Access is Lost
Mid-Procedure
  • Stop the blood infusion.
  • Attach, flush and run heparinized fluid through the blood infusion tubing to prevent clotting.
  • Consider replacing arterial access.If unsuccessful, convert the procedure to Venous Access Only.

 

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