Partial Volume Exchange Transfusion — Assess Vascular Access — Clinical Pathway: ICU

Partial Volume Exchange Transfusion, Clinical Pathway, ICU

Assess Vascular Access

Access Catheters Considerations
Umbilical Venous
  • Single
    • Vygon Exchange Transfusion set* contain 5Fr and 7 Fr single lumen catheters with side holes
  • Double
    • Use larger lumen for infusion of the replacement fluid (NS or PRBC)
  • Location of Catheter
  • RA/IVC junction — confirm not extending into RA via X-ray
  • Low lying — inserted 2-4 cm of depth beyond umbilical stump
  • If existing UVC not in place and there is not arterial access, use a catheter from the exchange transfusion kit as the side holes aid in blood withdrawal
  • If arterial or other venous access for blood removal is not available, an UVC can be used for both withdrawal and infusion using the exchange transfusion 4-way stopcock
  • If UVC in place as well as 2 PIVs but no arterial access
    • Use UVC for withdrawal
    • One PIV for infusion of replacement fluid
    • One PIV for maintenance fluids.
Umbilical Arterial
  • Single lumen catheter
  • Withdrawal using the exchange transfusion 4-way stopcock
Peripheral Venous or Peripheral Arterial

Minimum of 2 PIVs for

  1. Infusion of replacement fluid (PRBC or NS)
  2. Maintenance fluids/medications
  • Increased risk of losing access during the procedure with only peripheral access
  • Larger/longer catheters are ideal to help maintain ease of infusion/removal and longevity of catheter for the length of the procedure
  • If using a PIA for withdrawal, do not need to use exchange transfusion 4-way stopcock. Syringes on the usual withdrawal port for labs can be used.

*Kits vary depending on hospital. This procedure is specific to the CHOP (main) N/IICU based on the equipment we use and related CHOP hospital policies and procedures

For PVET, infusion of the replacement NS or PRBC through a PIV is a reasonable option. Vigilance must be had to the PIV site as the infusion rate is higher than usual. Discussion should be had as to slowing the removal and infusion rates based on peripheral access to try and preserve the catheters throughout the procedure.