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Red Blood Cell Exchange (Adult and Pediatric) (1.04AP)

Red Blood Cell Exchange (Adult and Pediatric) (1.04AP) - Policies, Clinical, UWHC Clinical, Department Specific, Nursing Patient Care, Cardiovascular and Infusion

1.04AP

NURSING PATIENT CARE POLICY & PROCEDURE





Effective Date:
June 30, 2017

Administrative Manual
Nursing Manual (Red)
Other _______________

Policy #: 1.04AP

Original
Revision

Page
1
of 3

Title: Red Blood Cell Exchange (Adult &
Pediatric)

I. PURPOSE

To provide guidance for the exchange of red blood cells by apheresis procedure for
the therapeutic management of patients with sickle cell disease crisis. Sickle red
blood cells (RBCs) are exchanged by apheresis with donor normal red cells. The
procedure can provide medical relief in sickle cell crisis accompanied by acute chest
syndrome, priapism and mental deterioration. Red cell exchange can also be used in a
prophylactic management mode.

II. POLICY

Red blood cell exchange is performed only by apheresis in the Infusion Center or
remotely by Infusion Center RNs.

III. EQUIPMENT AND SUPPLIES

A. Spectra Optia apheresis instrument
B. Disposable Exchange Tubing set (Special Order # 10220)
C. IV solutions
1. 0.9% sodium chloride – 1,000 mL
2. Anticoagulant Citrate ACD-A solution – 1,000 mL
D. Venipuncture/venous access device supplies
E. Astotherm Blood warmer with tubing set (Special Order #IFT40410)
F. Donor packed red cells for exchange
G. Standard consent form

IV. PROCEDURE

A. Obtain order from Transfusion Medicine physician via Apheresis Therapy plan.
B. Verify patient consent from Transfusion Medicine Physician has been signed by
the patient or authorized representative.
C. Set up Spectra Optia apheresis instrument with disposable exchange tubing set
according to the Spectra Optia Apheresis Operator’s manual chapter 8 pp. 89-102.
D. Obtaining Replacement Blood for Erythrocytapheresis
1. The extent of red cell exchange for a given patient is based on the severity
of the patient's clinical condition, pre-apheresis levels of normal
hemoglobin (Hba) and sickle hemoglobin (HbS) and desired post-
apheresis levels of HbA and HbS. The extent of red cell exchange is

Page 2 of 3

decided in consultation between the referring physician and the apheresis
attending physician.
2. Donor blood to be used for red cell exchange is obtained from the Blood
Bank. Blood used for exchange is to be type compatible and leuko-
reduced, by filtration, prior to exchange. Leuko-reduction is indicated as
there have been reports of significant leukoagglutination reactions
occurring in patients undergoing red cell exchange with non-leuko-
reduced red cells.
3. Once the number of red cell units to be exchanged has been determined by
the attending physician, send the order for the appropriate amount of
packed red cells. These pre-filtered units are stored in our Blood Bank and
refrigerated prior to use.
4. Red cell units are transported from the Blood Bank to the apheresis unit in
a cooler provided by the Blood Bank. The temperature of the units is
maintained at 1-6 degrees Celsius. Exchange flow rates are rapid during
erythrocytapheresis, therefore, to reduce patient discomfort, the blood
warming device should be used.
5. The apheresis program for red cell exchange utilizing the Spectra Optia
requires input data on the average hematocrit of the replacement red cell
units. Leuko-reduction, by filtration, does not significantly change the unit
hematocrit. The Blood Bank will be stocking and supplying only Adsol
units with an average hematocrit of 57%.
E. Select procedure on Optia for red blood cell exchange.
F. Prime tubing set according to Spectra Optia Manual Chapter 8.
G. Set up blood warmer according to manufacturer’s instructions.
H. Access patient venipuncture/venous access device according to Nursing Patient
Care Policies 1.23, Continuous Peripheral Intravenous Therapy and 1.28, Care of
Hemodialysis/Apheresis Catheters. Do not apply needleless access device.
I. Proceed to Spectra Optia Manual Chapter 8. Follow the prompts and perform the
RBC exchange as outlined.
J. Monitor and document patient vital signs pre, during, post procedure, and as
needed for patient symptoms.
K. Disconnect patient according to Spectra Optia Operator’s when procedure is done.
L. Follow UW Health Clinical Policy 4.1.8, Standard Precautions and Isolation, for
disposal of materials.
M. Document in patient's clinical record; diagnosis, type of therapeutic procedure
performed, method used, nature and volume of component removed, nature and
volume of replacement fluids, any occurrence of adverse reactions, and
medication administered.

V. Monitoring

A. As a monitor of efficiency of red cell exchanges, pre and post-apheresis
hemoglobin electrophoresis samples should be drawn as ordered. Blood samples
are drawn in lavender top tubes (EDTA) and sent to Clinical Lab. Instruct the lab
that the samples represent pre and post-apheresis specimens, and request that they
be analyzed on the same electrophoretic gel to obtain comparative percentages of
HbA and HbS.
B. Spectra Optia Maintenance and alarm check for accuracy.

Page 3 of 3


VI. UWHC CROSS REFERENCES

A. UW Health Clinical Policy 4.1.8, Standard Precautions and Isolation for Inpatient
Setting
B. Nursing Patient Care Policy 1.23, Continuous Peripheral Intravenous Therapy
C. Nursing Patient Care Policy 1.28, Care of Hemodialysis/Apheresis Catheters
D. Nursing and Patient Care Policy 1.56 AP, Central Vascular Access Device Use,
Maintenance and Removal (Adult & Pediatric)

VII. REFERENCE

A. Spectra Optia Operator’s Manual
B. Blood Warmer Manual

VIII. REVIEWED BY

Clinical Nurse Specialist, Infusion Center
Manager, Clinical Labs-Transfusion Service
Nurse Clinician, Infusion Center
Nurse Manager, Infusion Center
Nursing Patient Care Policy and Procedure Committee, June 2017

SIGNED BY

Beth Houlahan, DNP, RN, CENP
Senior Vice President, Chief Nurse Executive