Partial Volume Exchange Transfusion, Clinical Pathway, ICU

Risks-Complications-Troubleshooting

Risks	Electrolyte imbalances (hypocalcemia, hyperkalemia), hypoglycemia Dysrhythmias Coagulopathy/thrombosis Infections Possible contributor to NEC IV infiltrate Hypotension/Hypertension Air embolus
Potential complications	Signs suggesting a patient is not tolerating the procedure: Metabolic acidosis Hypotension Dysrhythmias If not tolerating the procedure: Consider decreasing the volume removed with each pass Check for, and correct, electrolyte abnormalities Ensure lines remain in appropriate position
Troubleshooting	What to do if you lose your withdrawal (arterial) access mid-procedure: STOP the infusing fluid (NS or PRBC) Attach, flush and run heparinized fluid through the blood infusion tubing to prevent clotting Attempt to replace arterial access (refer to Assess Vascular Access) If unsuccessful, convert the procedure to the Venous Access Only exchange procedure

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.