Hetastarch (Hydroxyethyl Starch; HES)

A to Z Drug Facts

Hetastarch (Hydroxyethyl Starch; HES)

	Action
	Indications
	Contraindications
	Route/Dosage
	Interactions
	Lab Test Interferences
	Adverse Reactions
	Precautions
Patient Care Considerations
	Administration/Storage
	Assessment/Interventions
	Patient/Family Education

(HET-uh-starch)

Hespan

Class: Plasma expander

Action Produces expansion of plasma volume. Does not have oxygen-carrying capacity or contain plasma protein, so it is not blood or plasma substitute.

Indications Adjunct therapy for plasma volume expansion in shock due to hemorrhage, burns, surgery, sepsis, or other trauma; adjunct in leukapheresis to improve harvesting and increase yield of granulocytes.

Contraindications Severe bleeding disorders; severe cardiac failure; renal failure with oliguria or anuria.

Route/Dosage

Plasma Volume Expansion

ADULTS: IV 500 to 1000 ml/day; dosage does not usually exceed 1500 ml/day.

Leukapheresis

ADULTS: IV 250 to 700 ml.

Interactions None well documented.

Lab Test Interferences May alter coagulation and result in transient prolongation of prothrombin time (PT), partial thromboplastin time (PTT), bleeding and clotting times, decreased Hct and excessive plasma protein dilution; increases indirect bilirubin concentrations.

Adverse Reactions

CNS: Headache. DERM: Itching. EENT: Submaxillary and parotid glandular enlargement. GI: Vomiting. OTHER: Anaphylactoid reactions (eg, periorbital edema, urticaria, wheezing, mild temperature elevation); chills; mild influenza-like symptoms; muscle pain; peripheral edema of lower extremities.

Precautions

Pregnancy: Category C. Lactation: Undetermined. Children: No data available. Special risk patients: Due to possibility of circulatory overload, take special care when administering to patients with renal impairment, at risk of pulmonary edema, or with CHF. Hypersensitivity: May cause anaphylactoid reactions.

PATIENT CARE CONSIDERATIONS

Administration/Storage

Administer by IV infusion only.
Store at room temperature.
Do not use if solution is turbid deep brown or if crystalline precipitate forms.

Assessment/Interventions

Obtain complete history, including drug history and any known allergies.
Assess for bleeding disorders and severe cardiac failure with oliguria or anuria.
Take baseline vital signs and hematologic parameters before administration of drug.
Check vital signs q 5 min for first 30 min following administration.
Monitor urinary output. If output does not increase, report to health care provider.
Monitor CVP during infusion to assess for circulatory overload (elevated CVP, rales/crackles, shortness of breath during and after administration).
Report prolonged PT, PTT, bleeding and clotting times, decreased Hct, decreased plasma proteins to health care provider.
Report anaphylactoid reactions (eg, periorbital edema, urticaria, wheezing, fever), chills, muscle pain, peripheral edema to health care provider.
During leukapheresis, monitor CBC, differential WBC count, Hgb, Hct, PT, and PTT.

Patient/Family Education

Instruct patient to report these symptoms to health care provider: Itching, dyspnea, chills, myalgia, headache, vomiting and glandular enlargement.