HES, Hespan, Hydroxyethyl Starch, Hextend
Classifications: plasma volume expander; Therapeutic: plasma volume expander
Pregnancy Category: C
6 g/100 mL injection
Synthetic starch closely resembling human glycogen. Acts much like albumin and dextran but is claimed to be less likely
to produce anaphylaxis or to interfere with cross matching or blood typing procedures. Causes no significant alterations
in fibrinogen or clotting time but may prolong the PTT and PT. Not a substitute for blood or plasma.
In hypovolemic patients, it increases arterial and venous pressures, heart rate, cardiac output, urine output, and collodial
osmotic pressure. Colloidal osmotic properties are approximately equal to those of human serum albumin.
Early fluid replacement and plasma volume expansion when whole blood is not available or when there is no time for necessary
cross matching. Used to expand plasma volume during cardiopulmonary bypass and in adjunctive treatment of shock caused by
hemorrhage, burns, surgery, sepsis, or other trauma. Also used as an agent for sediment agent in preparation of granulocytes
As a priming fluid in pump oxygenators for perfusion during extracorporeal circulation and as a cryoprotective agent for
long-term storage of whole blood.
Severe bleeding disorders, CHF, renal failure with oliguria and anuria, treatment of shock not accompanied by hypovolemia,
intracranial bleeding; pregnancy (category C). Safe use in children is not established.
Hepatic or renal insufficiency, pulmonary edema in the very young or older adults, patients on sodium restriction.
Route & Dosage
|Plasma Volume Expansion
Adult: IV 5001000 mL or 20 mL/kg/d (max: 1500 mL/d)
Adult: IV 250750 mL infused at a constant fixed ratio of 1:8 to venous whole blood
Clcr <10 mL/min: use original initial dose, then reduce doses by 2550%
PREPARE: IV Infusion: Use undiluted as prepared by manufacturer.
ADMINISTER: IV Infusion: Specific flow rate is prescribed by physician. Rate may be as high as 20 mL/kg/h in acute hemorrhagic shock. Rate is usually
reduced in patients with burns or septic shock.
INCOMPATIBILITIES Y-site: Amikacin, amphotericin B, cefoperazone, cefotaxime, cefoxitin, diazepam, gentamicin, ranitidine, sodium bicarbonate, theophylline, tobramycin.
- Store at room temperature; avoid extremes of heat or cold.
- Discard partially used bags.
Adverse Effects (≥1%) CV:
Peripheral edema, circulatory overload, heart failure. Hematologic:
With large volumes, prolongation of PT, PTT, clotting time, and bleeding time; decreased Hct, Hgb, platelets, calcium, and
fibrinogen; dilution of plasma
proteins, hyperbilirubinemia, increased sedimentation rate. Body as a Whole:
Pruritus, anaphylactoid reactions
(periorbital edema, urticaria, wheezing), vomiting, mild fever, chills, influenza-like symptoms, headache, muscle pains,
submaxillary and parotid glandular swelling.
No clinically significant interactions established.
2436 h. Distribution:
Remains in intravascular space. Metabolism:
In reticuloendothelial system. Elimination:
In urine with some biliary excretion.
Assessment & Drug Effects
- Monitor for S&S of hypersensitivity reaction (see Appendix F).
- Measure and record I&O. Report oliguria or significant changes in I&O ratio.
- Monitor BP and vital signs and observe patient for unusual bruising or bleeding.
- Lab tests: Monitor WBC count with differential, platelet count, and PT & PTT during leukapheresis.
- Observe for signs of circulatory overload (see Appendix F).
- Check laboratory reports of Hct values. Notify physician if there is an appreciable drop in Hct or if value approaches 30%
by volume. Hct should not be allowed to drop below 30%.
Patient & Family Education
- Notify physician for any of the following: Difficulty breathing, nausea, chills, headache, itching.