NEONATAL SERVICES EXCHANGE TRANSFUSION RECORD

Name Hospital Number DOB Sheet number

Total volume of exchange Aliquot volume

Total time for exchange Time per aliquot

Blood gas, FBC, U and E, When

LFT, SBR and clotting to be blood Record observations at least every 30 mins
Volume of blood in Volume of blood out taken at beginning, middle taken
Date Time via UVC/PVL via UVC/UAC/PAL and end of exchange
(please circle route) (Please circle route)
Blood Respiratory Blood
Please indicate below when Infant temp Heart rate Saturations
sugar rate pressure
samples taken

Standards group/CM June 2008

 NEONATAL SERVICES EXCHANGE TRANSFUSION RECORD

Name Hospital Number DOB Sheet number

Blood gas, FBC, U and E, When

LFT, SBR and clotting to be blood Record observations at least every 30 mins
Volume of blood in Volume of blood out taken at beginning, middle taken
Date Time via UVC/PVL via UVC/UAC/PAL and end of exchange
(please circle route) (Please circle route)
Blood Respiratory Blood
Please indicate below when Infant temp Heart rate Saturations
sugar rate pressure
samples taken

Standards group/CM June 2008