.

DEXTRAN 70

Medical Diagnosis and Drugs, Medications
DEXTRAN 70
(dex'tran)
Macrodex
DEXTRAN 75
Gentran 75
Classifications: plasma volume expander;
Therapeutic:plasma volume expander
Prototype: Albumin
Pregnancy Category: C

Availability

6% solution in D5W or NS

Action

High-molecular-weight polysaccharide. The colloidal osmotic effect of dextran draws fluid into the vascular system from the interstitial spaces, resulting in increased circulating blood volume and decreasing blood viscosity.

Therapeutic Effect

Cardiovascular response to volume expansion includes increased BP, pulse pressure, CVP, cardiac output, venous return to heart, and urinary output.

Uses

Primarily for emergency treatment of hypovolemic shock or impending shock caused by hemorrhage, burns, surgery, or other trauma. Intended for emergency treatment only when whole blood or blood products are not available or when haste precludes cross-matching of blood.

Unlabeled Uses

Nephrosis, toxemia of pregnancy, and prophylaxis of deep vein thrombosis.

Contraindications

Known hypersensitivity to dextrans; severe bleeding disorders; severe CHF; coagulopathy; severe renal failure; pregnancy (category C), lactation.

Cautious Use

Impaired renal function, pulmonary edema, CHF, pathologic GI disorders; thrombocytopenia.

Route & Dosage

Shock
Adult: IV 500 mL administered rapidly (over 15–30 min), additional doses may be given more slowly up to 20 mL/kg in the first 24 h (doses up to 10 mL/kg/d may be given for an additional 4 d if needed)

Administration

Intravenous

PREPARE: IV Infusion: Use only if seal is intact, vacuum is detectable, and solution is absolutely clear.  

ADMINISTER: IV Infusion: Specific flow rate should be prescribed by physician. For emergency treatment of shock, rate of administration for first 500 mL may be 20–40 mL/min; thereafter, unless patient is hypovolemic, rate should not exceed 4 mL/min.  

  • Store at a constant temperature, preferably 25° C (77° F).

Adverse Effects (≥1%)

All: Allergic reactions, urticaria, wheezing, mild hypotension, nausea, vomiting, fever, arthralgia, severe anaphylactoid reaction.

Pharmacokinetics

Onset: Volume expansion within minutes of infusion. Duration: 12 h. Metabolism: Degraded to glucose and metabolized to carbon dioxide and water over a period of a few weeks. Elimination: 75% in urine within 24 h; small amount in feces.

Nursing Implications

Assessment & Drug Effects

  • Observe closely for S&S of anaphylaxis (see Appendix F) especially during first 30 min of infusion. Severe reactions have resulted in fatalities.
  • Note: Bleeding time may be temporarily prolonged in patients receiving more than 1000 mL of dextran 70 or 75.
  • Monitor I&O ratio and pattern. Monitor vital signs frequently as warranted by condition of patient.

Patient & Family Education

  • Report immediately S&S of bleeding to physician: Easy bruising, blood in urine, or dark tarry stool.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

(25)