Polyglucinum

Polyglucinum – drug with plasma substituting, antishock action.

Form of release and structure

Polyglucinum produce in the form of solution for infusions 6%: transparent, colourless or with slightly yellowish shade (on 100, 200 or 400 ml in bottles (large bottles) or bottles for blood and blood substitutes; on 100, 200, 250, 400, 500 or 1000 ml in the polyolefin packages (bags)).

Is a part of 1 ml:

• Dextran with a molecular weight of 50 000-70 000 – 60 mg;
• Sodium chloride – 9 mg;
• Water for injections – to 1 ml.

Indications to use

• Operational interventions and conservative treatment of states which are followed by a pachemia and a syndrome of the increased viscosity (for the purpose of improvement of microcirculation and a haemo rheology, decrease in tendency to fibrinferments);
• Disturbances of a venous and arterial blood-groove (for its normalization);
• Disturbances micro and macrohemodynamics, improvement of rheological properties of blood;
• Thrombosis;
• IDCS (prevention);
• Depressed cases because of acute blood loss, including at an extrauterine pregnancy, childbirth, injuries, the combined defeats, intoxications and sepsis;
• Ischemic stroke;
• Shock (burn and operational).

When using cardiopulmonary bypasses Polyglucinum is added to perfused liquid.

Contraindications

Absolute:

• Craniocereberal injuries;
• Cardiovascular and heavy chronic renal failure;
• Hemorrhagic stroke;
• Increase in intracranial pressure;
• Thrombocytopenia;
• Anury;
• Clinical situations at which introduction of large volumes of liquids is undesirable, including arterial hypertension, a hyperpotassemia against the background of a hematocrit indicator lower than 0,3;
• Hypersensitivity to drug components.

Relative (Polyglucinum is appointed with care in the presence of the following diseases / states):

• The proceeding internal bleedings (renal, pulmonary, etc.), except cases of development of disturbances of a hemodynamics in a heavy current (falling of arterial pressure is lower than 60 mm hg). The drug is administered till the moment until arterial pressure rises above a critical level. After that the patient is transferred to hemotransfusion, plasmas;
• The expressed dehydration. Before administration of solution of Polyglucinum it is necessary to recover deficit of liquid;
• Metabolic acidosis;
• The expressed abnormal liver functions;
• The lowered level of phosphates in blood;
• Danger of developing of hypostases at functional disturbances of kidneys in cases if carrying out regular control of content of magnesium in blood is impossible;
• The urolithic diathesis connected with disturbance of exchange of magnesium, calcium and ammonium of phosphate.

The feeding and pregnant women can enter Polyglucinum only after an advantage ratio with possible risk for health of mother and the child.

Route of administration and dosage

Polyglucinum is entered in stationary conditions intravenously kapelno. At acute blood losses intra arterial introduction is shown.

Speed and volume of administration of solution establish depending on a condition of the patient, pulse rate, size of arterial pressure, a respiration rate, a hematocrit, coloring of integuments.

It is necessary to begin drug transfusion kapelno. After introduction of the first 10 and subsequent 30 drops it is necessary to interrupt introduction for 3 minutes. In the absence of reaction signs (in the form of increase of pulse, lowering of arterial pressure, a dermahemia, breath difficulty) transfusion is continued.

At the developed shock solution of Polyglucinum is entered intravenously struyno. Average one-time volume – 400-1200 ml (increase up to 2000 ml is possible). At increase in arterial pressure to figures, close to norm, it is reasonable to continue administration of drug by a drop method with a speed of 3-3,5 ml/min. (60-80 caps/min.). Infusions should be carried out, constantly controlling the main indicators of a system hemodynamics. In case of substantial increase of the central venous pressure reduce a dose and rate of administering of Polyglucinum or completely cancel therapy. At the expressed anemization and blood loss more than 500 ml reasonablly combined use with packed red cells transfusion or suspensions of erythrocytes, and also blood, freshly frozen plasma with the maintenance of factors of system of a hemostasis. Use of Polyglucinum does not exclude need of holding other antishock actions (using anesthetics, heart, tonic and hormonal drugs).

When carrying out operations with the purpose of prevention of operational shock, prevention of a thrombogenesis and reduction of a tendency to progressing or development of the IDCS intravenous injection of solution of Polyglucinum produce in 30-60 minutes prior to operational intervention kapelno in a dose 5-10 ml/kg, in cases of falling of arterial pressure pass to jet introduction. At sharp lowering of arterial pressure (it is lower than 60 mm of mercury.) it is recommended to transfer the patient to intra arterial introduction on average volume to 400 ml. Jet and drop administration of drug belongs to effective remedies of prevention of postoperative shock in the postoperative period. To children Polyglucinum is entered of 10-15 ml/kg.

During surgical influence the volume of infusions is defined by the size of operational blood loss (the hematocrit should not go down lower than 0,3).

At burn shock the following scheme of use of Polyglucinum is shown:

• First 24 hours: adult – 2000-3000 ml, children – 40-50 ml/kg;
• Next 24 hours: adult – 1500 ml, children – 30 ml/kg.

Administration of solution of Polyglucinum depending on indications can be combined with the following substances / drugs:

• Deep and extensive burns: albumine, plasma, gamma-globulin;
• Burns more than 30-40% of a body surface: hemotransfusion.

For the purpose of prevention of possible dehydration of fabrics is shown to combine performing infusion with administration of crystalloid solutions (a ratio – 1:2).

Side effects

Possible side effects: fervescence, a lowering of arterial pressure, increase of pulse, allergic reactions (in the form of a skin itch, urtikarny rashes, a Quincke's edema).

Special instructions

Bystry introduction of large volumes of dextrans can provoke edematization of lungs and an acute left ventricular failure.

Introduction of Polyglucinum by standard methods (prior to a research it is recommended to wash erythrocytes of 0,9% NaCl solution) does not interfere with blood typing and carrying out cross matching. Presence at blood of a dextran can exert impact on results of the fermental methods based on papain. When carrying out researches of content of glucose in blood with use of solutions of acetic and sulfuric acids obtaining concentration of glucose is possible more, than is actually.

Solution of Polyglucinum lowers transparency of blood, and also can lead to change of results of measurement of concentration of protein and bilirubin (blood samples are recommended to be taken before administration of drug).

Drivers of vehicles and patients whose profession demands high concentration of attention should apply Polyglucinum with care.

Medicinal interaction

The combined use of Polyglucinum with other widely applied transfusion means is allowed.

Terms and storage conditions

To store in the place, unavailable to children, at a temperature up to 25 °C.

Period of validity – 5 years.

Solution maintains freezing, it can be transported at a temperature up to -10 °C. On condition of preservation of tightness of packaging freezing of Polyglucinum a contraindication to its use is not.