HETASTARCH

HETASTARCH (het'a-starch) HES, Hespan, Hydroxyethyl Starch, Hextend Classifications: plasma volume expander; Therapeutic: plasma volume expander Prototype: Albumin Pregnancy Category: C

Availability

6 g/100 mL injection

Action

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.

Therapeutic Effect

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.

Uses

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 by leukapheresis.

Unlabeled Uses

As a priming fluid in pump oxygenators for perfusion during extracorporeal circulation and as a cryoprotective agent for long-term storage of whole blood.

Contraindications

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.

Cautious Use

Hepatic or renal insufficiency, pulmonary edema in the very young or older adults, patients on sodium restriction.

Route & Dosage

Plasma Volume Expansion Adult: IV 500–1000 mL or 20 mL/kg/d (max: 1500 mL/d) Leukapheresis Adult: IV 250–750 mL infused at a constant fixed ratio of 1:8 to venous whole blood Renal Impairment Clcr <10 mL/min: use original initial dose, then reduce doses by 25–50%

Administration

Intravenous 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.

Interactions

Drug: No clinically significant interactions established.

Pharmacokinetics

Duration: 24–36 h. Distribution: Remains in intravascular space. Metabolism: In reticuloendothelial system. Elimination: In urine with some biliary excretion.

Nursing Implications

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.

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