plasma expanders

1. PLASMA
EXPANDERS

2. • Blood is a fluid connective tissue that
circulate continuously around the body.
• Plasma is a clear, straw coloured, watery
fluid in which several different types of
blood cells are suspended ( plasma is
blood devoid of blood cells).
• Serum is plasma without clotting factors

3. Plasma Volume Expanders
• Volume expanders are the intravenous fluid
solutions that are used to increase or retain the
volume of fluid in the circulating blood.
• Generally volume expanders are used to
replace fluids that are lost due to illness,
trauma or surgery.

4. Types of Volume Expanders
There are two main types of volume
expanders:
1. Crystalloids
2. Colloids

5. 1. Crystalloids
Crystalloids are aqueous solutions of
mineral salts or other water-soluble
molecules.
E.g. Normal Saline, Dextrose, Ringer’s Solution
etc.

6. Cont..
Indications:
• Crystlloid fluids are used to provide the daily
requirements of water and electrolytes.
• They should be given to critically ill patients as
a continuous background infusion, to
supplement fluids or to carry drugs.
• Correction of metabolic acidosis (sodium bi-
carbonate)

7. 2. Colloids
Colloids are larger insoluble molecules,
such as Dextran, Human Albumin, Gelatin and
Blood.

8. Colloids are better than Crystalloids
because:
• The larger molecules of colloids are retained
more easily in the intravascular space &
increase osmotic pressure.
• So, more effective resuscitation of plasma
volume occurs by colloids than produced by
that of crystalloids.
• Duration of action is relatively longer than
crystalloids.

9. Mechanism of Action
• Generally works on the principle of osmosis.
Increases Plasma osmotic pressure, drawing
water into plasma from interstitial fluid.
• Since the lost blood is replaced with a suitable
fluid, the now diluted blood flows more easily,
even in small vessels.
• As a result of chemical changes, more oxygen is
released to the tissues.

10. COMMON PLASMA EXPANDERS
1. Human albumin
2. Dextran
3. Polygeline or Degraded gelatin polymer
4. Hetastarch or Hydroxyethyl starch

11. 1. HUMAN ALBUMIN
• Prepared from pooled human plasma.
• It can be used irrespective of patient’s blood
group
• It is used in patients of hypovolemia, burns,
shock, hypoproteinemia, acute liver failure and
dialysis.
• It can cause hypersensitivity and overloading
of intravascular fluid volume.
• It is available as 5% and 20% 100ml infusion.
• Albudac, Albupan 10, 50, 100 ml inj.
• Albumed 20% infusion (100ml)

12. 2. DEXTRAN
• It is polysaccharide and is available in two forms,
Dextran-70 and Dextran-40. It is obtained from
sugar beet.
• It interfere with blood grouping
• Its dose should not exceed 20ml/kg in 24 hours
for adults.
• It is not recommended for children.
• It can cause anaphylactic reaction, urticaria,
itching bronchospasm and prolongation of
bleeding time.

13. 3. POLYGELINE
• It is synthetic polymer (polypeptide) of MW-
30,000.
• It does not show any interference with blood
grouping and cross matching.
• It can cause hypersensitivity reactions like
urticaria, flushing, wheezing and hypotension.
• Available in 3.5% solution .
• Drugs available:-Haemaccel; Seraccel 500ml
injection.

14. 4. HETASTARCH
• It is derived from starch (mixture of ethoxylated
amylopectin of various molecular sizes; average
MW 4.5 lacs)
• Doesn’t show any interference with blood
grouping and cross matching.
• The main side effect with its use are vomiting,
mild fever, itching, flu like symptoms, swelling
of salivary glands, urticaria, periorbital odema
bronchospasm.
• Drugs available:- Expan, Hestar, Pentorch 500
ml injection

15. Indications
• Burns
• Hypovolemic shock,
• Severe trauma,
• Surgical procedures
• Dialysis
• Extensive fluid loss.

16. Contraindications
• Plasma expanders are contraindicated in
congestive heart failure,
• Renal failure,
• Hepatic failure,
• Pulmonary edema.
• Allergy
• Thrombocytopenia

17. ADVERSE EFFECTS
• Circulatory overload
• Heart failure
• Peripheral edema
• Urticaria
• Nausea, vomiting
• Myalgia
• Prolongation of clotting time and bleeding
time
• Hypersensitivity
• Hypotension (when administered polygeline)

18. NURSING RESPONSIBILITIES
• If blood samples are after administration, inform
lab as Dextran interfere with platelet function,
KFT and LFT.
• Before administration, check ordered product
correctly (molecular weight)
• Check vitals at regular intervals.
• When administering Dextran, check for blood
grouping and cross matching.
• Infuse at rate as prescribed by physician.
• Blood test should be done regularly.
• Monitor I/O chart and patients weight.
• Watch for signs of allergic reactions.