Alternate Name(s):
DEXTRAN-40, RHEOMACRODEX®, GENTRAN-40®, DEXTRAN-70, MACRODEX 6%
Classification:
Plasma volume expander
Original Date:
August 2005
Indications:
- 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
Compatibility:
- 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
Administration:
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | NO |
| IM | NO |
| IV Direct |
NO |
| IV Intermittent Infusion | NO |
| IV Continuous Infusion | YES Usual infusion rate: <4 mL/minute Emergency infusion rate: 20-40 mL/minute |
Dosage:
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
Adult/Pediatric:
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
Notes:
- 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)
ANAPHYLAXIS PRECAUTIONS:
- 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