Partial Volume Exchange Transfusion — Umbilical Venous Access Only PVET Procedure — Clinical Pathway: ICU

Partial Volume Exchange Transfusion, Clinical Pathway, ICU

Umbilical Venous Access Only PVET Procedure

Venous Access for withdrawal of blood AND infusion of replacement fluid
(NS or PRBC)

Pre-procedure
  • Make patient NPO (if not already)
  • Order IV fluids if current fluids are going through the catheter that will be needed for blood withdrawal
    • IVF will need to go through a peripheral IV
  • Hold TPN during procedure
  • Order carrier fluids for secondary lumens depending on vascular access
  • Order labs so that labels can be printed as needed
  • Identify the timer (apparatus) to be used during exchange
Sterile field preparation and 4-way stopcock assembly
  • This assembly is used when a single venous catheter is being used for both withdrawal of blood and infusion of replacement fluid.
  • STERILE FIELD PREPARATION (note this is a semi-sterile procedure as existing catheters are not sterile):
    • Stop phototherapy if patient receiving
    • PPE: All staff in room don hats and masks
    • Open exchange transfusion tray
    • Provider performing procedure don sterile gown and gloves
    • Establish sterile field on the warmer bed:
      • Disconnect any fluids running through UVC (stopcock with claves should remain on the UVC)
      • Have helper hold UVC up while a sterile drape/towel is placed down and clean UVC tubing with an alcohol wipe
      • Place the UVC tubing down on the sterile field
  • Assembling the stopcock:
    1. Place exchange transfusion stopcock and attached waste tubing (pre-attached to port B) on sterile field. Hand the waste bag and the distal end of the waste tubing to a non-sterile helper.
    2. Flush the stopcock and ports using the sterile saline syringe.
    3. Attach donor blood tubing from hotline warmer to Port C using a t-connector between hotline warmer blood tubing. (Nurse should tape hot-line warmer tubing to the bed to secure and avoid accidental removal of the line). If for polycythemia, connect normal saline infusion line to Port C.
    4. Remove stopcock from the venous catheter, gently pinching the UVC to avoid blood leakage.
    5. Clean UVC hub with alcohol.
    6. Use the flush and overfill the venous catheter tip and then attach venous catheter to Port A. If you have a double lumen UVC, use larger lumen for exchange.
    7. Attach a syringe to main port to draw initial labs and hand syringe to nurse sending labs
    8. Attach an appropriate size syringe (depending on pass volume) to the Main port in preparation to start exchange

4-way stopcock
Final Prep for Procedure
Performing the procedure
  • The exchange transfusion 4-way stopcock works differently than a standard stopcock
  • The main port coming from the handle is ALWAYS OPEN and will be open to whichever port the handle is pointed towards
  • Always rotate the exchange transfusion stopcock CLOCKWISE
    1. Based on start time, determine the times labs should be drawn
    2. Start exchange transfusion record in EPIC (recording nurse)
    3. Based on anticipated length of the procedure, determine the times labs should be drawn
    4. Begin the exchange cycle
4-way stopcock 1
5a) Rotate the handle towards the UVC (patient) and withdraw pre-specified volume of blood over pre-specified length of pass.
4-way stopcock 2
5b) Rotate the handle towards waste bag. Discharge patient blood and call out volume withdrawn.
4-way stopcock 3

5c) Rotate the handle towards donor blood. Draw up volume of donor blood/Normal Saline equivalent to volume of blood withdrawn.

5d) Rotate the handle toward UVC (patient) and push in donor blood/normal saline over 1 minute and call out volume transfused (Figure 5a)

5e) Repeat steps until the next scheduled lab draw
  1. Labs should be drawn after the step in the cycle of passes where the patient’s blood is withdrawn so that the UVC is cleared of any blood.
  2. Detach this syringe and hand off rather than discarding into waste bag. Requires a hub scrub before connecting new syringe. Attach a new sterile syringe to restart your cycle.