CHHS16/095

Canberra Hospital and Health ServicesClinical GuidelineCord Blood Collection for Blood Group, Direct Coomb’s test (DCT) and Blood Gas Sampling

Contents

Contents.................................................................................................................................................1

Purpose..................................................................................................................................................2

Scope......................................................................................................................................................2

Alert.......................................................................................................................................................2

Section 1 – Cord Blood collection for Group and DCT in Maternity and Operating Theatre (OT)...........2

Section 2 – Collection of Cord Blood for Umbilical Cord Blood Gas Sampling........................................4

Implementation......................................................................................................................................6

Related Legislation, Policies and Standards............................................................................................6

References..............................................................................................................................................6

Definition of Terms.................................................................................................................................7

Search Terms..........................................................................................................................................7

Attachments...........................................................................................................................................7

Attachment 1: Flowchart for Cord Blood Collection in the Operating Theatre.....................8

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Purpose

This 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 Test how to identify babies who require cord blood gas sampling who is responsible for the blood collection the process for collecting the blood.

Scope

This Clinical Procedure is applicable to: Medical Officers Midwives 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.

Alert

If 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 haemolysis born to Blood Group O positive women visibly jaundiced at birth pre 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 hernia known haemolytic disease with in-utero transfusions or anaemia.

Equipment

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ACT Health Pathology request form EDTA ( pink tube) Serum gel ( yellow top) 10/20ml syringe BD Vacutainer –Blood Transfer Device

Procedure - MaternityMidwife: as per Attachment 1: Flowchart for Cord Blood Collection in the Operating Theatre

Completion 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 birth date of baby’s birth and sex area/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

status sign and print your name the date, time and indicate the sample “cord blood”

Blood collection check that the baby’s details exactly match the pathology request form collect 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 times label 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 pathology

Procedure - OT:Theatre Scrub Nurse: as per Attachment 1: Flowchart for Cord Blood Collection in the Operating Theatre check that the baby’s details exactly match the pathology request form alert the scout nurse that they are about to collect the cord blood so the scout nurse

can witness the collection collect the cord blood for the baby’s cord into a gallipot draw up the collected blood into a 10/20ml syringe pass 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 TheatreDoc Number Version Issued Review Date Area Responsible PageCHHS16/095 1 08/07/2016 01/01/2019 WY&C 3 of 8

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CHHS16/095

witness the cord blood collection aspirate 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 clotting labels 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 name date and time of birth specimen type.

Obstetric Medical Officer It is the responsibility of the obstetric medical officer to sign the pathology form.

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Section 2 – Collection of Cord Blood for Umbilical Cord Blood Gas Sampling

BackgroundUmbilical 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 liquor neonatologist/neonatal registrar present at birth preterm gestation planned neonatal nursery admission assisted vaginal birth emergency or non-elective caesarean section vaginal breech delivery shoulder dystocia maternal thyroid disease intrapartum haemorrhage

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small for gestational age twins fetal scalp pH during labour apgar score < 5 at 1 minute or <7 at 5 minutes. IRGDM All labours with Continuous Fetal monitoring (CEFM) regardless of classification.

Equipment required: gloves heparinised blood gas syringes x 2 needles 21g x 2 personal Protective Equipment (PPE), eye and face shield, gloves, gown cord clamps x 4 maternal 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.

Procedure use heparinised pre-packed blood gas syringe by attaching a 21g (green) needle to each

syringe withdraw 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 provided label the syringe with all of the following details:

o the mother’s surnameo ‘Baby of’ and the mother’s first nameo ‘Twin 1’ and ‘twin 2’ for multiple birtho date of baby’s birth and sexo area/ward (Birthing, Birth Centre or OT)o date and time of sample and identify as arterial or venous

obtain 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.

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Normal cord blood gas and PH (during and post labour)At term pH Base Excess

mmol/LpO2 (mmHg) pCO2 (mmHg) Lactate

mmol/LArterial 7.10-7.38 -9.0 to 1.8 4.1 to 31.7 39.1 to 73.5 <6.1

Venous 7.20-7.44 -7.7 to 1.9 30.4 to 57.2 14.1 to 43.3

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Implementation

Education to staff will be provided at appropriate education and in-service opportunities

document will be available online via the electronic portal

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Related Legislation, Policies and Standards

ProceduresJaundice in the NewbornPatient Identification: Pathology Specimen LabellingMaternity-Collection of cord blood and tissue for private banking

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References

1. King Edward Memorial Hospital (2014). Umbilical cord blood collection/analysis-at birth. Women and newborn health service

2. 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.

3. National Institute for Health and Clinical Excellence. The guidelines manual 2010. London: NICE; 2010.

4. Royal Hospital for women (2007). Umbilical cord blood sampling guideline. Clinical Performance and Quality

5. 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.

6. South Australian perinatal practice guidelines (2014) umbilical cord blood gas sampling

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Definition of Terms

Cord blood: blood taken from the umbilical cord at or just after birth

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Jaundice -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

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Search 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 cord

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Attachments

Attachment 1: Flowchart for Cord Blood Collection in the Operating Theatre

Disclaimer: 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 Amended Section Amended Approved ByE.g.: 17 August 2014 Section 1 ED/CHHSPC Chair

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Attachment 1: Flowchart for Cord Blood Collection in the Operating Theatre

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Midwife

The Midwife provides the cord blood pack (yellow blood tube, pink blood tube, transfer device, pathology form) to Scout NurseCollect cord gas specimens , label as per Patient Identification - Pathology Specimen Labelling DGD16-017 Procedure and send to pathology for processing

Scrub Nurse

Alert the Scout Nurse when the cord blood is about to be collected so that the scout nurse can witness the collectionAssist with the collection of cord blood from the Baby's cord into a gallipotEnsure collection is received by Scout Nurse

Scout Nurse

Witness the cord blood collectionAspirate the cord blood via the blood transfer device into the pink tube (EDTA) and the yellow tube (Serum gel)Rotate the tubes 6-8 times each to prevent clottingLabel the blood tubes as per Patient Identification - Pathology Specimen Labelling DGD16-017 Procedure. Blood tubes and form must be labelled by hand - DO NOT USE PATIENT STICKERSend specimens to pathology