Indications for use
The drug is used as part of complex therapy. Prevention and treatment of traumatic, surgical and burn shock; disorders of arterial and venous circulation, treatment and prevention of thrombosis and thrombophlebitis, endarteritis; for addition to the perfusion fluid during cardiac operations performed using a heart-lung machine; to improve local circulation in vascular and plastic surgery; for detoxification of burns, peritonitis, pancreatitis. Diseases of the retina and optic nerve.
special instructions
When the drug is administered into peripheral veins, a burning sensation and pain may occur in the limb along the vein.
Together with the drug, it is advisable to administer crystalloid solutions (0.9% sodium chloride solution, 5% dextrose solution) in such quantities as to replenish and maintain water-electrolyte balance. This is especially important when treating dehydrated patients and after surgery.
Particular caution should be exercised when there is a risk of circulatory overload, especially in the case of latent or clinically overt heart failure.
Dextran reduces plasma levels of coagulation factor VIII and platelet von Willebrand factor, mainly due to dilution, which may cause bleeding, especially in patients with a deficiency of these factors when using dextran in daily doses exceeding 1.5 g/kg body weight body (approximately 15 ml/kg body weight). When used simultaneously with anticoagulants, it is necessary to reduce their dose.
Causes an increase in diuresis (if there is a decrease in diuresis with the release of viscous, syrupy urine, this may indicate dehydration). In this case, it is necessary to administer crystalloid solutions intravenously to replenish and maintain water and electrolyte balance. If oliguria occurs, it is necessary to intensify the therapy and prescribe furosemide. In patients with reduced filtration capacity of the kidneys, it is necessary to limit the administration of sodium chloride.
Dextrans can coat the surface of red blood cells, preventing the determination of blood group, so it is necessary to use washed red blood cells.
The drug may be frozen during transportation.
Impact on the ability to drive vehicles and operate machinery
During the treatment period, care must be taken when driving vehicles and engaging in potentially hazardous activities that require increased concentration and speed of psychomotor reactions.
Rheopolyglukin-40
Individual, determined by the patient’s condition, blood pressure, heart rate, hematocrit.
Intravenous stream, stream-drip and drip. The dose and rate of administration of the drug should be selected individually, in accordance with the indications and condition of the patient.
When using the drug, it is necessary to conduct a bioassay:
after slowly introducing the first 5 drops of the drug, stop the transfusion for 3 minutes, then add another 30 drops and stop the infusion again for 3 minutes. If there is no reaction, the administration of the drug continues. The results of the bioassay must be recorded in the medical history.
1. In case of disruption of capillary blood flow (various forms of shock)
administered intravenously by drip or jet-drip, in a dose of 0.4 to 1.0 l per day (for 30-60 minutes) until hemodynamic parameters stabilize at a life-supporting level. If necessary, the amount of the drug can be increased to 2 liters.
In children with various forms of shock, it is administered at a rate of 5-10 ml/kg, the dose can be increased if necessary to 15 ml/kg. It is not recommended to reduce the hematocrit value below 25%.
2. For cardiovascular and plastic surgeries
administered intravenously, immediately before surgery for 30-60 minutes for adults and children at a dose of 10 ml/kg, during surgery for adults - 500 ml, for children - 15 ml/kg and after surgery the drug is administered intravenously (over 60 minutes) for 5-6 days at the rate: adults - 10 ml/kg once, children under 2-3 years old - 10 ml/kg once a day, children under 8 years old - 7-10 ml/kg 1-2 times per day, children under 13 years old - 5-7 ml/kg 1-2 times a day.
For children over 14 years of age, the doses are the same as for adults.
3. During cardiopulmonary bypass operations
the drug is added to the blood at the rate of 10-20 ml/kg of the patient’s body weight to fill the oxygenator pump, while the concentration of dextran in the perfusion solution should not exceed 3%. In the postoperative period, the doses of Reopoliglucin-40 are the same as for cases of capillary blood flow disturbance.
4. For the purpose of detoxification
administered intravenously in a single dose from 500 to 1250 ml (in children 5-10 ml/kg) for 60-90 minutes. If necessary, on the first day the dose can be increased by 400-500 ml of the drug (in children, the administration of Reopoliglucin-40 on the first day can be repeated in the same doses). In the following days, the drug is administered dropwise, for adults - at a daily dose of 500 ml per day, for children - at a rate of -10 ml/kg. Together, it is advisable to administer crystalloid solutions (Ringer's and Ringer's acetate, etc.) in such quantities as to normalize the water-electrolyte balance (especially important when treating dehydrated patients and after surgical operations); the drug, as a rule, causes an increase in diuresis (a decrease in diuresis indicates to dehydrate the patient).
5. In ophthalmological practice
Reopolyglucin-40 is used by electrophoresis in the generally accepted way, 10 ml once a day, current density up to 1.5 mA/cm2, for 15-20 minutes. The procedure is carried out once a day, administered from both the positive and negative poles. The course of treatment consists of 5-10 procedures.
Directions for use and doses
Intravenous drip.
The dose is set individually and depends on the clinical situation and condition of the patient, blood pressure, heart rate, hematocrit. Due to the possibility of developing anaphylactic reactions, the drug is administered slowly during the first 10-20 minutes.
When using the drug, it is necessary to conduct a biotest: after slowly introducing the first 5 drops of the drug, stop the transfusion for 3 minutes, then introduce another 30 drops and stop the infusion again for 3 minutes. If there is no reaction, the administration of the drug continues.
In order to prevent and treat capillary blood flow disorders associated with traumatic, surgical and burn shock, use 400-1000 ml per day (for 30-60 minutes).
In children, it is administered at a rate of 5–10 ml/kg; the dose can be increased, if necessary, to 15 ml/kg.
It is not recommended to reduce the hematocrit value below 25%.
In case of arterial and venous circulation disorders, treatment and prevention of thrombosis and thrombophlebitis, endarteritis - 400 ml once a day for 5 - 10 days.
To improve local circulation during vascular and plastic surgeries, 10 ml/kg is administered to adults and children for 30–60 minutes before surgery; during surgery, adults — 400–500 ml; children — 15 ml/kg. After surgery, the drug is administered over 60 minutes for 5-6 days at the rate of:
adults - 10 ml/kg per administration;
children under 2-3 years old - 10 ml/kg 1 time per day, children under 8 years old - 7-10 ml/kg 1-2 times per day, children under 13 years old - 5-7 ml/kg 1-2 times a day, for children over 14 years old - the dose for adults.
During heart operations using a heart-lung machine, the drug is added to the blood at the rate of 10–20 ml/kg of the patient’s body weight to fill the oxygenator pump. The concentration of dextran in the perfusion solution should not exceed 3%. In the postoperative period, the doses of the drug are the same as for cases of capillary blood flow disturbance.
For detoxification in case of burns, peritonitis, pancreatitis, a single dose of 500 to 1200 ml (in children 5 - 10 ml/kg) is administered for 60-90 minutes. If necessary, you can pour another 500 ml of the drug on the first day (in children, the administration of the drug on the first day can be repeated in the same doses). In the following days, the drug is administered to adults at a daily dose of 500 ml, to children - at a rate of 5 - 10 ml/kg.
For diseases of the retina and optic nerve, it is used by electrophoresis, which is carried out in the generally accepted way. The drug consumption per procedure is 10 ml. The procedure is carried out once a day, administered from both the positive and negative poles. Current density – up to 1.5 mA/sq.cm. The duration of the procedure is 15 – 20 minutes. The course of treatment consists of 5 – 10 procedures.
Reopoliglyukin
Individual, determined by the patient’s condition, blood pressure, heart rate, hematocrit values. IV jet, jet-drip and drip. Doses and rates of administration should be selected individually in accordance with the indications and condition of the patient. Immediately before using the drug, with the exception of urgent cases, a skin test is performed. To do this, after treating the injection site with ethanol in the middle part of the inner surface of the forearm, 0.05 ml is injected intravenously to form a lemon peel. The presence of redness at the injection site with a diameter of more than 1.5 mm, the formation of a papule or the appearance of symptoms of a general reaction of the body in the form of nausea, dizziness and other manifestations 10-15 minutes after the injection indicate hypersensitivity of the patient to the drug (one or more of its components) - risk group .
When using the drug, it is necessary to conduct a biotest: after slowly introducing the first 5 drops of the drug, stop the transfusion for 3 minutes, then inject another 30 drops and stop the infusion again for 3 minutes. If there is no reaction, the administration of the drug continues. The results of the bioassay must be recorded in the medical history.
1. In case of disruption of capillary blood flow (various forms of shock), administer IV drip or jet-drop, in a dose of 0.5 to 1.5 l, until hemodynamic parameters stabilize at a life-supporting level. If necessary, the amount of the drug can be increased to 2 liters.
In children with various forms of shock, it is administered at a rate of 5-10 ml/kg, the dose can be increased if necessary to 15 ml/kg. It is not recommended to reduce the hematocrit value below 25%.
2. For cardiovascular and plastic surgeries, administered intravenously by drip, immediately before surgery, for 30-60 minutes for adults and children at a dose of 10 ml/kg, during surgery for adults - 500 ml, for children - 15 ml/kg. kg. After surgery, the drug is administered intravenously (over 60 minutes) for 5-6 days at the rate of: adults - 10 ml/kg once, children under 2-3 years old - 10 ml/kg once a day, children under 8 years - 7-10 ml/kg 1-2 times a day, children under 13 years old - 5-7 ml/kg 1-2 times a day. For children over 14 years of age, the doses are the same as for adults.
3. During operations with artificial circulation, the drug is added to the blood at the rate of 10-20 ml/kg of the patient’s body weight to fill the oxygenator pump. The concentration of dextran in the perfusion solution should not exceed 3%. In the postoperative period, the doses of the drug are the same as for cases of capillary blood flow disturbance.
4. For the purpose of detoxification, administer intravenously in a single dose of 500 to 1250 ml (in children 5-10 ml/kg) for 60-90 minutes. If necessary, you can pour another 500 ml of the drug on the first day (in children, the administration of the drug on the first day can be repeated in the same doses). In the following days, the drug is administered dropwise, for adults - at a daily dose of 500 ml, for children - at a rate of 5-10 ml/kg. Together, it is advisable to administer crystalloid solutions (Ringer's and Ringer's acetate, etc.) in such quantities as to normalize the water-electrolyte balance (especially important when treating dehydrated patients and after surgical operations); the drug, as a rule, causes an increase in diuresis (a decrease in diuresis indicates to dehydrate the patient).
5. In ophthalmological practice, it is used by electrophoresis, which is carried out in a generally accepted way. The drug consumption per procedure is 10 ml. The procedure is carried out once a day, administered from both the positive and negative poles. Current density - up to 1.5 mA/sq.cm. The duration of the procedure is 15-20 minutes. The course of treatment consists of 5-10 procedures.
Side effect
Allergic reactions (skin flushing, skin rash, anaphylactoid reactions - decreased blood pressure, collapse, oliguria), nausea, fever, fever, chills.
Overdose
Symptoms: increased dose-dependent side effects.
Overdose can lead to various pathological changes in the lungs, tissue dehydration, renal failure, pathological intra- and postoperative bleeding. The main symptoms are volume overload (pulmonary edema, cerebral edema, etc.), decreased blood coagulation, oliguria, anuria, and the development of arterial hypertension.
Treatment: depending on the clinical situation, you should immediately begin all emergency measures provided for in the relevant instructions (administration of cardiovascular drugs, respiratory analeptics, corticosteroids, crystalloid solutions, vasopressors, diuretics and other drugs depending on the patient’s condition).
Overdose and negative effects
Mostly side effects occur in patients with an overdose. The most common negative reactions:
- allergy;
- decreased blood pressure (hypotension);
- circulatory overload;
- decrease in daily diuresis.
Due to a possible allergic reaction, it is necessary to administer the drug slowly and monitor the patient's reaction. Given the possibility of developing arterial hypotension, it is necessary to keep intensive care supplies on hand. To avoid heart failure from circulatory overload, it is advisable to monitor the patient's condition during drip administration.
When using a dropper with Reopoliglucin, there is a risk of blood clotting disorders, which often provokes bleeding. If the daily volume of urine decreases, the doctor prescribes additional intravenous injections with crystalloid solutions. Also, during infusion therapy, it is necessary to reduce the amount of salt consumed, especially if the patient suffers from renal failure and other kidney pathologies.
