CPT® Code 36455

1. Indications

The exchange transfusion procedure, coded as CPT® 36455, is indicated for various medical conditions that necessitate the rapid replacement of a patient's blood volume. The following are specific indications for performing this procedure:

• Severe Anemia - This condition may arise from various causes, including chronic disease, nutritional deficiencies, or bone marrow disorders, necessitating the need for blood volume restoration.
• Hemolytic Disease - Conditions such as hemolytic anemia or transfusion reactions can lead to the destruction of red blood cells, requiring exchange transfusion to remove damaged cells and replace them with healthy donor blood.
• Blood Disorders - Certain hematological disorders may require exchange transfusion to correct abnormal blood composition and improve oxygen-carrying capacity.

2. Procedure

The exchange transfusion procedure involves several critical steps to ensure its effectiveness and safety. The following outlines the procedural steps involved in CPT® 36455:

• Step 1: Preparation - The physician prepares the exchange equipment and ensures that all necessary materials, including donor blood, are ready for the procedure. This preparation is crucial for maintaining a sterile environment and ensuring the availability of blood products.
• Step 2: Catheter Placement - Using a two-catheter push-pull technique, the physician selects an appropriate artery and vein for the procedure. Catheters are inserted into the selected sites, allowing for simultaneous blood withdrawal and infusion.
• Step 3: Blood Exchange - Blood is withdrawn from the selected artery at a controlled rate. Concurrently, donor blood is infused through the vein at the same rate. This simultaneous process helps maintain hemodynamic stability and ensures that the patient's blood volume remains consistent throughout the exchange.
• Step 4: Monitoring - Throughout the procedure, the physician closely monitors the patient's vital signs and overall condition to ensure safety and effectiveness. Adjustments may be made as necessary to optimize the exchange process.
• Step 5: Completion - The procedure continues until the desired volume of blood has been exchanged, typically aiming to replace a significant portion of the patient's blood volume to achieve the therapeutic goals.

3. Post-Procedure

After the exchange transfusion is completed, the patient is monitored for any adverse reactions or complications that may arise from the procedure. This includes observing for signs of transfusion reactions, such as fever, chills, or changes in vital signs. The healthcare team may perform follow-up blood tests to assess the effectiveness of the transfusion and ensure that the patient's blood parameters have improved. Additionally, the patient may require supportive care and monitoring for a period to ensure a stable recovery and to address any potential issues that may arise post-procedure.