Parenteral Manual


Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Plasma volume expander
Original Date: 
August 2005
  • Fluid replacement
  • Plasma volume expansion
  • For use by Division of Plastic Surgery in microvascular surgery cases (Dextran 40 only)                                          
Reconstitution and Stability: 
  • Available as 6% dextran 70 in 0.9% NaCl
  • Available as 10% dextran 40 in D5W                                                               
  • Store at room temperature            
  • DO NOT administer unless clear
  • If dextran flakes form on storage, heat in a water bath at 100 degrees C until clear, cool to body temperature before administering
  • Does not contain preservative; discard unused portion


- Solutions Compatible: dextrose up to D10W, 0.9% NaCl, dextrose-saline combinations, ringer's solution, ringer's lactate

- Additives/Above Cassette Compatible: no information

- Y-site Compatible: no information

Incompatible: blood, do not mix with any other drugs


(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

IV Direct


IV Intermittent Infusion NO
IV Continuous Infusion YES
Usual infusion rate: <4 mL/minute    
Emergency infusion rate: 20-40 mL/minute

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Volume expansion/Shock:

  • Maximum dose for 1st day: 20 mL/kg  
  • Subsequent doses: not to exceed 10 mL/kg/day
  • Therapy should not proceed beyond 5 consecutive days
Potential hazards of parenteral administration: 
  • Anaphylaxis: have epinephrine and diphenhydramine at bedside
  • Urticaria, tightness of chest, wheezing, hypotension, nausea and vomiting
  • Circulatory overload
  • Pulmonary edema with high doses, dyspnea
  • Hypotension
  • Acute renal failure
  • Thrombocytopenia
  • May interfere with blood cross-matching, blood sugar determinations, bilirubin or total protein assays    
  • Use with caution in patients with heart failure, pulmonary edema, CHF, thrombocytopenia, impaired renal function
  • Caution in patients with bleeding disorders, active hemorrhage (increased perfusion pressure and improved microcirculatory flow may result in increased blood loss)
  • Caution in patients in whom sodium is restricted: 500 mL of 6% Dextran-70 or 10% Dextran-40 in NS contains 77 mmol of NaCl
  • Assess urine output:  contraindicated in patients with renal disease who have severe oliguria or anuria (may be used if decreased urinary output due to shock improves after the drug is given)
  • Dextran increases viscosity and specific gravity of urine, especially in patients with decreased urine flow; low specific gravity of urine during dextran therapy may indicate a failure of dextran clearance
  • Assess hydration; renal failure has occurred following administration to dehydrated patients
  • If anuria or oliguria develops, discontinue dextran (osmotic diuretic may be indicated to minimize vascular overloading)

- Have epinephrine, diphenhydramine and hydrocortisone available at bedside and in portable kit for patient transport off unit 
- Dosage guidelines (Administer in sequence listed):

  • Epinephrine (Adrenalin®) (1:1,000 is 1 mg/mL)______ mg = _______mL(0.01 mg/kg/dose = 0.01 mL/kg/dose, Max. 0.5 mg = 0.5 mL) IM in the thigh or alternative large muscle q15 minutes x 2, then Q4H PRN.
  • Diphenhydramine [Benadryl®] __________ mg (1 mg/kg/dose, Max. 50 mg) I.V. x 1, then Q6H PRN
  • Hydrocortisone [Solu-cortef®] __________ mg (2.5 mg/kg/dose) I.V. x 1, then Q4H PRN

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