Team Con:

Prepared by:

Rhea Sildo
Rae Dawn

Prepared for:

Mr. Rojel Magarro, RN

Clinical Instructor

November 25, 2010

 PLASMA EXPANDERS

Plasma Expanders are substances, usually a high-molecular-weight

dextran, that are administered intravenously to increase the oncotic
pressure of a patient. Plasma expanders are used to restore the circulating
volume of a hypovolemic patient. Plasma volume expanders have a MW >
35,000.

 COLLOIDS
 Definition:
 a chemical system composed of a continuous medium
(continuous phase) throughout which are distributed small particles,
1 to 1000 nm in size (disperse phase), that do not settle out under
the influence of gravity; the particles may be in emulsion or in
suspension. The term may be used to denote either the particles or
the entire system.
 Colloids contain larger insoluble molecules, such as gelatin;
blood itself is a colloid.

 Indication:
 fluid resusitation in severely dehydrated patients (ex.
hemorrhagic shock)
 fluid resusitation in patient with hypoalbuminemia
 conditions with loss of large amounts of proteins (ex. burns)

 DEXTRAN
 Definition:
 a water-soluble polymer of glucose of high molecular weight. A
purified form, having an average molecular weight of 75,000, is used
in a 6% concentration in isotonic sodium chloride solution to expand
plasma volume and maintain blood pressure in emergency treatment
of hemorrhagic and traumatic shock.

 a water-soluble polysaccharide of glucose (dextrose) produced

by the action of Leuconostoc mesenteroides on sucrose; used as a
plasma volume extender. Several preparations of dextran are used as
anticoagulants.
 Polysaccharides which have been fractionated into different
molecular sizes
 Effective plasma expander with the increase in circulating
volume persisting for several hours
 Has a colloid osmotic pressure greater than plasma
 Indication:
 Prevention or treatment of shock associated with reduction in
circulating blood volume due to: haemorrhage, vomiting, diarrhoea,
loss of plasma [burns, crush injuries, peritonitis]
 Addition to prime in CPB
 Prophylaxis of postoperative & post-traumatic thromboembolism

 Cautions:
 The use of dextran to replace large volumes of plasma or blood
loss should be limited to 1 litre, since no plasma components are
being replaced
 Volumes > 1 litre may also interfere with haemostasis
 Contraindicated in DIC & thrombocytopaenia
 Presentation:
 Macrodex [Dextran 70 (av MW 70,000)]
 Rheomacrodex [Dextran 40 ( av MW 40,000)]
 Nursing Considerations:
 Assess patient’s fluid balance status.
 Obseerve temperature of the patient’s limbs, and the presence
or absence of edema, capillary refill time of less than 2 seconds
implies adequate hydration, and more than 2 seconds implies
reduced blood flow and therefore, hypovolemia.
 Monitor patient’s vital signs.
 Monitor intake and output
 Avoid isotonic sodium chloride if serum sodium is elevated.

 HETASTARCH
 Definition:
 are macromolecular substances which are metabolized slowly;
they may be used at the outset to expand and maintain blood volume
in shock arising from conditions such as burns or septicaemia. Plasma
substitutes may be used as an immediate short-term measure to
treat haemorrhage until blood is available. They are rarely needed
when shock is due to sodium and water depletion because, in these
circumstances, the shock responds to water and electrolyte repletion
 Indications
 Adjunctive therapy for plasma volume expansion in shock due to
hemorrhage, burns, surgery, sepsis, trauma
 Adjunctive therapy in leukapheresis to improve harvesting and
increase the yield of granulocytes
 Nursing Considerations
Assessment
 History: Allergy to hetastarch, severe bleeding disorders, severe
cardiac congestion, renal failure or anuria; liver dysfunction
  Physical: T; submaxillary and parotid gland evaluation; P, BP,
adventitious sounds, peripheral and periorbital edema; R,
adventitious sounds; liver evaluation; urinalysis, renal and liver
function tests, clotting times, PT, PTT, Hgb, Hct
Implementation
 Administer by IV infusion only; monitor rates based on patient
response.
 Maintain life support equipment on standby in cases of shock.
Drug-specific teaching points
 This drug can only be given IV.
 Report difficulty breathing, headache, muscle pain, skin rash,
unusual bleeding or bruising.