Bring the caffeine as we wrap up IUTs this week with our detailed step by step on the procedure itself. In this episode we talk about:
- The pre-operative process including consenting and lab studies
- Using the MCV value on a CBC to determine fetal vs. maternal sample (only works for the 1st IUT)
- Fetal sample= 105-110
- Maternal sample = 80s-90s
- How much blood to order from the blood bank for a transfusion
- <24 weeks order 1/2 unit (split it - save the other half for the next IUT!)
- 24-28 weeks order 1 unit
- 28-35 weeks order 2 units
- Fetal drug calculations
- Atropine = 0.02 mg/kg
- Fentanyl = 2 mcg/kg
- Vecuronium = 0.1 mg/kg
- Pre- & post-operative monitoring
- Pre-op = 20 min strip of toco + FHR
- Post-op = 2 hours continuous toco + FHR
- Patient positioning in the OR = left lateral tilt
- Patient comfort in the OR - aromatherapy kit, eye mask, spa music
- How we warm up the blood in the OR, who checks it and what we check
- Brief sidebar on CMV - what it is, why we want CMV negative donor blood and what we do if we can't get CMV negative blood
- How to decide your needle type for the procedure
- 3-inch vs 6-inch length - depending on the depth measure on ultrasound
- Quincke tip vs. Whitacre tip
- Deciding gauge/size
- 22G (<22 weeks)
- 20G (>22 weeks)
- Role of a coulter and automated hemocytometer outside the OR
- Fetal labs to order at an IUT
- At the 1st IUT
- Initial Fetal Sample: CBC, ABO/Rh, (Fetal Antigen type), reticulocyte count, DAT
- Final Fetal Sample: CBC, KB Stain +/- hemoglobin electrophoresis
- On all subsequent IUTs for that pregnancy
- Initial Fetal Sample: CBC, reticulocyte count
- Final Fetal Sample: CBC, KB stain +/- hemoglobin electrophoresis
- Patient questions to ask your provider prior to having an IUT performed:
- “How many IUT procedures do you perform in a year?”
- “What are your outcomes?”
- “Where/How did you get your training?”
Abbreviations:
- CBC = complete blood count
- MCV = mean corpuscular volume
- CMV = Cytomegalovirus
- KB Stain = Kleihauer-Betke Stain
- DAT = Direct Antiglobulin Test AKA Direct Coomb’s Test
