Hespan

[Aneroo, LPN]

Posting on behalf of my husband who works in the small little ICU/CCU at our local hospital:

How often do you use Hespan with patients who are in septic shock? He's noted that more boluses of NS and LR are used, and it wondering how the patients would do if Hespan were used more frequently instead.

Thanks!

[PrettyinPink1234]

Well I have heard from a few doctors that several studies have shown that Hextend is no more effective than NS clinically. The doctors I currently work with usually give Hextend often in the immediate post op period unless we are concerned the patient might be bleeding (Hextend may cause coagulopathy). So without looking anything up I would say that just by personal experience 500 cc-1000 cc of Hextend would probably benefit patient who are in septic shock, unless they have already reached the coagulopathy/phase or if their kidneys have already taken a hit, then they should prob just stick with saline.

[schroeders_piano, RN]

The only time I have used Hetastarch has been for hypovolemic shock or for the immediate post op phase. The ICU I worked in went with the old tried and true method of dumping massive amounts of NS into the patient, support BP with Levophed, and hanging Xigris as soon as possible for septic shock.

[ghillbert, MSN, NP]

It's great that you're asking questions. For evidence-based practice, try peer-reviewed journals.

The SAFE study of saline versus albumin for fluid resuscitation showed that there was no difference in outcomes at 28 days in ICU patients.

There may of course be need for albumin if pt has low serum albumin, etc.

Study at NEJM: http://content.nejm.org/cgi/content/abstract/350/22/2247

[cardiacRN2006, ADN, RN]

Hespan? Never. And I mean, Never. For any condition.

For Sepsis-Bolus, bolus, levophed, bolus. Most of our pts have contraindications to Xigris too. Only get to use that every so often...

[schroeders_piano, RN]

Hespan? Never. And I mean, Never. For any condition.

I'm curious why you say never on Hetastarch for any condition. I've used it quite a bit without any problems. I'm just wondering what others might have seen.

[sicushells, RN]

We use Hespan occassionally. Off the top of my head I think it might be more expensive than NS. I've never noticed a significant difference in pt response to Hespan vs. any other fluid. And there are always articles/research out there to read too! Though reading isn't really appealling after working all night.

[cardiacRN2006, ADN, RN]

I'm curious why you say never on Hetastarch for any condition. I've used it quite a bit without any problems. I'm just wondering what others might have seen.

Oh, I'm not against it or anything. I've just never, ever used it, that's all.

[ghillbert, MSN, NP]

We did have a patient recently who was allergic to hetastarch. An outside hospital admitted him to the ER and gave him filling with Hextend - he had an anaphylactic reaction, arrested and died.

[cvicugirl, BSN, RN]

In my experience, hespan has fallen out of use due to cost vs. benefit when compared to NS. Also, as PrettyinPink1234 mentions, coagulopathy and nephrotox are potential risks of use/overuse.

[meandragonbrett]

NS, LR, norepi, and vasopressin.

[Special31]

I work in a cvicu and we use hespan with the post ops only