Cord Blood Collection for Blood Group, Direct Coomb’s test ...



Canberra Hospital and Health ServicesClinical GuidelineCord Blood Collection for Blood Group, Direct Coomb’s test (DCT) and Blood Gas Sampling Contents TOC \h \z \t "Heading 1,1,Heading 2,2" Contents PAGEREF _Toc478985436 \h 1Purpose PAGEREF _Toc478985437 \h 2Scope PAGEREF _Toc478985438 \h 2Alert PAGEREF _Toc478985439 \h 2Section 1 – Cord Blood collection for Group and DCT in Maternity and Operating Theatre (OT) PAGEREF _Toc478985440 \h 2Section 2 – Collection of Cord Blood for Umbilical Cord Blood Gas Sampling PAGEREF _Toc478985441 \h 4Implementation PAGEREF _Toc478985442 \h 6Related Legislation, Policies and Standards PAGEREF _Toc478985443 \h 6References PAGEREF _Toc478985444 \h 6Definition of Terms PAGEREF _Toc478985445 \h 7Search Terms PAGEREF _Toc478985446 \h 7Attachments PAGEREF _Toc478985447 \h 7Attachment 1: Flowchart for Cord Blood Collection in the Operating Theatre PAGEREF _Toc478985448 \h 8PurposeThis document informs ACT Health staff:how to identify babies who are at risk of haemolytic disease and who require cord blood collection for Blood Group and Direct Coomb’s Testhow to identify babies who require cord blood gas samplingwho is responsible for the blood collectionthe process for collecting the blood.ScopeThis Clinical Procedure is applicable to:Medical OfficersMidwives and Nurses who have been deemed competent in the procedure, and who are working within their scope of practice Student midwives/nurses under direct supervision.AlertIf required, Umbilical Cord Blood Gas Collection is a priority to cord blood collection -refer to Section 2 of this document Section 1 – Cord Blood collection for Group and DCT in Maternity and Operating Theatre (OT)Indications for the collection of Blood Group and Direct Coomb’s Test (DCT)These include babies who are: born to Rhesus negative women born to women with known isoimmunisation or known antibody production which may cause haemolysisborn to Blood Group O positive women visibly jaundiced at birthpre term < 36 weeks a planned admission to NICU e.g. gastroschisis or congenital diaphragmatic hernia.Formal Cross Matching is to be requested for:babies <28 weeks - Extreme Prematurity known surgical condition requiring surgery in the newborn period eg. gastroschisis or congenital diaphragmatic herniaknown haemolytic disease with in-utero transfusions or anaemia.Equipment ACT Health Pathology request formEDTA ( pink tube)Serum gel ( yellow top) 10/20ml syringeBD Vacutainer –Blood Transfer DeviceProcedure - MaternityMidwife: as per Attachment 1: Flowchart for Cord Blood Collection in the Operating TheatreCompletion of Pathology Request FormHand write baby’s details on pathology request form, including all of the following and ensuring 3 baby identifiers: the mother’s surname‘Baby of’ and the mother’s first name‘twin 1’ and ‘twin 2’ for multiple birthdate of baby’s birth and sexarea/ward (Birthing, Birth Centre or OT)test required: Direct Coombs test (DCT) and Group (Grp) clinical details including recording the mother’s blood group, or maternal antibody statussign and print your name the date, time and indicate the sample “cord blood”Blood collectioncheck that the baby’s details exactly match the pathology request formcollect the cord blood from the baby’s cord into a container draw up the collected blood into a 10/20ml syringe then into the pathology tubes using the blood transfer device, rotate the tubes 6-8 timeslabel the pathology tubes with the 3 identifiers exactly as noted on the pathology request form, sign and date the tubes.send the cord blood specimen with the completed pathology form to pathologyProcedure - OT:Theatre Scrub Nurse: as per Attachment 1: Flowchart for Cord Blood Collection in the Operating Theatrecheck that the baby’s details exactly match the pathology request formalert the scout nurse that they are about to collect the cord blood so the scout nurse can witness the collectioncollect the cord blood for the baby’s cord into a gallipotdraw up the collected blood into a 10/20ml syringepass the collected blood in the syringe to the scout nurse.Theatre Scout Nurse: as per Attachment 1: Flowchart for Cord Blood Collection in the Operating Theatrewitness the cord blood collectionaspirate the cord blood via the blood transfer device into the EDTA ( pink tube) and serum gel (yellow top) rotate the blood filled specimen tubes 6-8 times to prevent clottinglabels blood tubes as above.It is the responsibility of the theatre staff to send the cord blood specimen with the completed pathology form to pathology. When sending the collected cord blood via the pathology chute the scrub / scout nurse will hand write the baby’s details in the Operating Theatre pathology register, as the baby will not have ID labels. Details to include:the surname of the mother‘baby of’ and the mother’s First namedate and time of birthspecimen type.Obstetric Medical Officer It is the responsibility of the obstetric medical officer to sign the pathology form.Back to Table of Contents Section 2 – Collection of Cord Blood for Umbilical Cord Blood Gas SamplingBackgroundUmbilical cord blood sampling provides valuable information regarding the status of the fetal metabolic condition at birth. Sampling can occur in Theatre or Maternity.Findings from the umbilical cord artery provide the most accurate information about fetal and newborn acid-base status, while the venous cord blood reflects a combination of maternal acid-base status and placental function.IndicationsCord blood should be taken from the cord artery and vein after birth in the following situations:Induction of labour meconium stained liquorneonatologist/neonatal registrar present at birthpreterm gestationplanned neonatal nursery admissionassisted vaginal birthemergency or non-elective caesarean sectionvaginal breech deliveryshoulder dystociamaternal thyroid diseaseintrapartum haemorrhagesmall for gestational agetwinsfetal scalp pH during labourapgar score < 5 at 1 minute or <7 at 5 minutes. IRGDMAll labours with Continuous Fetal monitoring (CEFM) regardless of classification.Equipment required:glovesheparinised blood gas syringes x 2needles 21g x 2personal Protective Equipment (PPE), eye and face shield, gloves, gowncord clamps x 4maternal identification labels.Cord Blood Gas Sampling TechniqueFor cord blood gas assessment, double clamp a 10 cm segment of the umbilical cord that is attached to the undelivered placenta, and obtain paired arterial and venous samples.Procedureuse heparinised pre-packed blood gas syringe by attaching a 21g (green) needle to each syringewithdraw a minimum of 0.2 ml blood from the artery as it contains less blood than the umbilical vein. This sample provides the most accurate information regarding fetal and newborn acid-base status (artery has a smaller lumen, thicker wall)ensure the extra air in the syringe is expelled before capping with stopper providedlabel the syringe with all of the following details:the mother’s surname‘Baby of’ and the mother’s first name‘Twin 1’ and ‘twin 2’ for multiple birthdate of baby’s birth and sexarea/ward (Birthing, Birth Centre or OT)date and time of sample and identify as arterial or venousobtain venous sample with second syringe, expel the extra air and cap the syringe with the stopper provided and label as above send the samples to pathology with a completed pathology request form inform neonatal and obstetric registrar if arterial cord gas blood pH result is <7.1, lactate > 4 or base excess -10.A clamped segment of cord blood is stable for pH and blood gas assessment for at least 30 minutes post delivery.If there is a possibility of a delay in analysing the specimens, place the syringes in slurry of crushed ice and water.Normal cord blood gas and PH (during and post labour)At term pHBase Excessmmol/LpO2 (mmHg)pCO2 (mmHg)Lactatemmol/LArterial7.10-7.38 -9.0 to 1.8 4.1 to 31.7 39.1 to 73.5<6.1 Venous7.20-7.44 -7.7 to 1.9 30.4 to 57.2 14.1 to 43.3Back to Table of ContentsImplementation Education to staff will be provided at appropriate education and in-service opportunitiesdocument will be available online via the electronic portalBack to Table of ContentsRelated Legislation, Policies and StandardsProceduresJaundice in the NewbornPatient Identification: Pathology Specimen LabellingMaternity-Collection of cord blood and tissue for private bankingBack to Table of ContentsReferencesKing Edward Memorial Hospital (2014). Umbilical cord blood collection/analysis-at birth. Women and newborn health service Kuzniewicz MW, Escobar GJ, Wi S et al. Risk factors for severe hyperbilirubinemia among infants with borderline bilirubin levels: a nested case-control study. Journal of Paediatrics 2008; 153:(2)234-40.National Institute for Health and Clinical Excellence. The guidelines manual 2010. London: NICE; 2010.Royal Hospital for women (2007). Umbilical cord blood sampling guideline. Clinical Performance and Quality Seidman DS, Ergaz Z, Paz I et al. Predicting the risk of jaundice in full-term healthy newborns: a prospective population-based study. Journal of Perinatology 1999; 19:(8 Pt 1)564-7.South Australian perinatal practice guidelines (2014) umbilical cord blood gas sampling Back to Table of ContentsDefinition of Terms Cord blood: blood taken from the umbilical cord at or just after birthJaundice -The yellow colouration of the sclera caused by the accumulation of bilirubin in the skin and mucous membranesVisable Jaundice- Jaundice detected by visual inspectionDCT - Direct Coombs Test Back to Table of ContentsSearch Terms Jaundice, Cord Blood, Direct Coomb’s Test, Rhesus Negative, Rh negative, Haemolysis, Rhesus negative, Group and DCT, Cord blood gases, Cord pH, Cord lactate, Cord blood lactate, Cord blood gas, Arterial, Venous cordBack to Table of ContentsAttachmentsAttachment 1: Flowchart for Cord Blood Collection in the Operating TheatreDisclaimer: This document has been developed by ACT Health, <Name of Division/ Branch/Unit> specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.Date AmendedSection AmendedApproved ByE.g.: 17 August 2014Section 1ED/CHHSPC ChairAttachment 1: Flowchart for Cord Blood Collection in the Operating Theatre ................
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