5. Dixon RE, Acosta AA, Young RL. Penrose pessary management of neonatal genital prolapse. Am J Obstet Gynecol 1974; 119 : 855-857.

Peripheral Exchange Transfusions Sir, The umbilical vein has been traditionally cannulated for exchange transfusions in the newborns. The technique, though easy during the first exchange, definitely creates problems of cannulation second exchange onwards. Thus repeated exchanges, which are commonly required in the premature become a problem. Furthermore, even temporary umbilical venous catheterization may be associated with morbid and mortal complications. An excellent alternative is using peripheral arterial cannulation to withdraw blood from the patient. We use either the radial or the braehial artery cannulated with a venflon, insyte or abocath. Blood is withdrawn through this line, while donor blood is infused through a peripheral venous line. The intra-arterial line is connected to a three-way and an outlet line for waste blood. The intravenous line is connected to a threeway and donor's blood. The technique is a simultaneous push-pull technique, push through rite venous line and pull through the arterial line.

Vol. 59, No. 5

pull). (iii) exchange can be done in much less than the usual one hour (the recommended time for a central exchange). (iv) the intra-arte.rial line may be fi~.ed, left in and used for other investigations as well as for repeated exchanges.' The disadvantages are: (i) difficulty in cannulating an artery. (ii) three persons are necessary, one to pull, one to push and a third to monitor the viral par~nelers. (iii) inability to measure CVP.: What began off as a technique for partial exchanges for polycythemia in our NICU, has blossomed into a full scale alternative to double volume exchange transfusion when umbilical venous catheterization becomes impossible. In fact, we have not required a supraumbilical venous cutdown for exchange transfusion in the past two years. M. Sanklecha, S. Khambadkone and S.F. lrani

Neonatology Intensive Care Unit, K.E.M. Hospital, Parel, Bombay-12 REFERENCES

1. Klaus MIt, Fanaroff AA. Care of the HighRisk Neonate. Philadephia; W.B. Saunders Company, 1986; 428-431. 2. Scott J. Iatrogenic lesions in babies following umbilical venous catheterization. Arch Dis Child 1985; 40 : 426.

The various advantages it offers are: (i) usefifl when umbilical venous cannulation is difficult, (ii) avoids ischemia-hyperperfusion associated with the pull-push technique through the umbilical vein (thus avoiding many sideeffects including NEC since the peripheral exchange ensues simultaneous push and

Acquired Malaria - How Early Can It Occur Sir, A male baby of 24 clays was admitted with history of fever, excessive crying, irritability

Peripheral exchange transfusions.

646 THE INDIAN JOURNAL OF PEDIATRICS 5. Dixon RE, Acosta AA, Young RL. Penrose pessary management of neonatal genital prolapse. Am J Obstet Gynecol...
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