Medical Procedure: Exchange Blood Transfusion

Exchange Blood Transfusion

• Definition: A medical procedure replacing a patient's blood with donor blood to remove harmful substances or treat medical conditions. Blood components like plasma, red blood cells, and platelets may be infused.

Purposes for Exchange Blood Transfusion

• Low platelet count (thrombocytopenia): Provides platelets, often due to chemotherapy.
• Severe anemia: Increases red blood cells.
• Removing harmful substances: Removes harmful antibodies or toxins.
• Increased blood volume: Increases blood volume after surgery, trauma, or hemorrhage.
• Counteracting jaundice: Counteracts the effects of jaundice.
• Hyperbilirubinemia treatment: Treats elevated bilirubin levels.

Types of Exchange Blood Transfusion

• Partial Exchange: Replaces a portion of the patient's blood; used for severe hyperbilirubinemia (especially in newborns) and hemolytic diseases.
• Double Volume Exchange: Replaces twice the patient's blood volume.
• Plasma Exchange: Removes patient plasma and replaces it with donor plasma; used for autoimmune disorders and poisoning.
• Red Blood Cell Exchange: Replaces a portion of a patient's red blood cells with donor red blood cells.
• Platelet Exchange: Removes and replaces a patient's platelets with donor platelets; treats low platelet counts and bleeding disorders.
• White Blood Cell Exchange: Replaces a patient's white blood cells with donor white blood cells.
• Total Exchange: Replaces the patient's entire blood volume.
• Cord Blood Exchange: Collects blood from the umbilical cord and placenta at birth for stem cell therapy; used for treating anemia, sickle cell disease, and leukemia.

Causes/Etiology of Exchange Transfusion

• Hemolytic Disease of the Newborn (HDN): May involve ABO or Rh incompatibility.
• Severe Jaundice: Often a result of HDN or premature birth.
• Prematurity: Increased risk.
• Sickle Cell Disease: Associated with needing the procedure.
• Sepsis
• Thrombocytopenia - Low platelet count
• Neutropenia - Low White blood cells
• Anemia

Side Effects of Exchange Blood Transfusion

• Fever and Chills: Possible reaction during procedure.
• Dark/Red Urine: Can be a sign of complications or adverse reaction.
• Electrolyte Imbalances: Possible consequence of blood replacement.
• Headache, Dizziness, Nausea, Vomiting: Symptoms potentially related to transfusion complications.
• Rash, Hives, Itching: Allergic reaction possibilities.
• Hypotension: Low blood pressure, a possible complication of transfusion.
• Bruising at IV site: Possible damage from cannula insertion or blood infusion.
• Difficulty breathing, chest pain: Can be manifestations of transfusion complications.

Complications and Nursing Management

• Allergic Reaction: Managing symptoms such as rashes, dyspnea, flushing, hives/pruritis. Immediate cessation of transfusion.
• Hemolytic Reaction: Managing fever, chills, dark urine; stop transfusion; maintain access.
• Bloodborne Infections: Administering antibiotics/antivirals as needed.
• Acute Lung Injury (ALI): Continuously monitoring respiratory status; assessing oxygen saturation; providing oxygen therapy as needed.
• Circulatory Overload: Managing symptoms like cough, dyspnea, distended neck veins as required.
• Graft-versus-Host Disease: Monitoring organ function, symptoms, and administering prescribed medications.

Nursing Assessment and Preparation

• Patient indication: Evaluating patient's need for transfusion.
• Physician's order: Verifying the correct blood product and dosage.
• Patient history: Reviewing reactions and pre-transfusion medications.
• Baseline vital signs: Comparing with transfusion vital signs to assess response.
• Venous access: Assessing type, integrity, and patency.
• Blood product verification: Verifying blood type with another nurse.
• Hospital policy review: Adhering to all relevant institutional policies.

Equipment Preparation

• Clean tray: Consisting of a blood administration set with filter, saline solution (0.9%NaCl), gloves, adhesive tape, kidney basin, and medication card.
• Blood products: Correct blood type, bag number; compatibility forms.
• Syringe/Flush solution: Distilled water, normal saline, or heparin for blockage prevention.
• IV pole: Appropriate height for maintaining IV infusion.
• Sterile tray: Emergency medications.
• Infusion pump: When required.

Nursing Procedure

• Physician's order verification.
• Patient education.
• Informed consent.
• Baseline vital signs.
• Blood collection.
• Blood product verification.
• Patient hydration check
• Monitoring vital signs.
• Setting up single/double tubing system.

Recording and Reporting

• Transfusion details: Date, time, blood type, blood group, bag number, start/end time, and flow rate.
• Adverse reactions: Documentation of any issues.
• Vital signs: Continuous monitoring before, during, and after transfusion.

Firefly/Phototherapy

• Description: Utilizing specialized light to treat various medical conditions.

Conditions Treated and Duration

• Jaundice (Newborns): 24-96 hours; severe cases: 12-24 hours; follow-up: bilirubin level checks every 12-24 hours.
• Seasonal Affective Disorder (SAD): 20-30 minutes daily; 2-6 weeks; mood assessments needed
• Circadian Rhythm Disorders: 10-30 minutes daily;1-4 weeks; sleep-wake cycle assessment.
• Psoriasis: 2-3 times per week; 6-12 weeks; skin checks.
• Vitiligo: 2-3 times per week; 3-6 months; skin checks.

Firefly Phototherapy Pathphysiology

• Non-thermal light: Safe therapeutic use.
• ATP production enhancement: Cellular repair/regeneration.
• Inflammation reduction: promoting healing and collagen production.
• Circadian rhythm regulation: Can improve mood and sleep.
• Bilirubin breakdown (Newborns): Treats jaundice by breaking down excess bilirubin.

Types of Firefly Phototherapy

• UVB Phototherapy: Slows skin cell turnover (psoriasis, eczema, vitiligo, other skin issues).
• Blue Light Therapy: Targets acne bacteria; treats jaundice.
• Red & Infrared Light Therapy: Penetrates deeper for pain management and tissue repair.
• White Light Therapy: Mimics sunlight to treat SAD
• Led portable therapy: Portable device containing light source.

Benefits of Firefly Phototherapy

• Non-invasive: No major incisions or surgical procedures
• Minimal side effects.
• Cost-Effectiveness: Potentially less expensive than comparable procedures.
• Effective bilirubin reduction: Treats jaundice in newborns.
• Prevents kernicterus: Brain damage prevention in newborns with jaundice.

Risks

• Skin burns: Prolonged or improper exposure
• Eye damage: Eyes must be protected if using UV or other strong light sources
• Photosensitivity: Can cause increased sensitivity to sunlight
• Hypothermia: Possible cooling in a treatment environment
• Dehydration: Increased fluid loss during treatment possible
• Skin cancer development: Light therapy treatment should not induce skin cancer

Safety Precautions (Newborns)

• Eye protection: Shield baby's eyes.
• Temperature monitoring: Regular checks to prevent overheating or cooling.
• Correct Positioning: Expose as much skin as possible to treatment light.
• Hydration and Feedings: Ensure adequate fluid intake; breastfeeding preferred.
• Therapy Duration: Follow provider directives; frequency of light exposure.
• Frequent Monitoring: Tracking bilirubin levels, vital signs continuously.
• Skin Care: Gentle moisturizers to reduce dryness.
• Avoid interruptions: Minimize interruptions of treatment periods; maintain proper skin exposure for effective treatment.
• Proper diagnosis: Confirmation of appropriate application.
• Appropriate type and dose: Using correct light source for each condition, appropriate dosages.
• Minimize handling: To prevent skin irritation and discomfort in the treated patient.

Explore the critical medical procedure of exchange blood transfusion. This quiz covers its definitions, purposes, and types, including partial and double volume exchanges. Ideal for medical students or healthcare professionals looking to deepen their understanding of blood transfusions.