How do I administer Voluven (hydroxyethyl starch)?

Administration of Voluven (Hydroxyethyl Starch)

Voluven (hydroxyethyl starch 130/0.4) should be administered by intravenous infusion only, with a maximum dose of 50 mL/kg body weight per day, followed by saline if additional fluid is needed. 1

Administration Protocol

• Administer Voluven by intravenous infusion only, never by other routes 1

• Before administration:

  • Visually inspect the solution for particulate matter and discoloration 1
  • Use only if solution is clear and container and seals are intact 1
  • Withdraw or expel all air from the bag through the medication port prior to infusion if using pressure infusion 1

• Dosing guidelines:

  • Adults: 500 to 1000 mL is typically administered, with doses exceeding 1500 mL per day (approximately 20 mL/kg) usually not required 1
  • Maximum daily dose: 50 mL/kg body weight per day 1
  • If additional fluid is needed after reaching the maximum daily dose, continue with 0.9% sodium chloride 1

Clinical Considerations and Contraindications

• Strong recommendation against using hydroxyethyl starches for intravascular volume replacement in patients with sepsis or septic shock due to increased risk of kidney injury and mortality 2, 3

• Crystalloids are recommended as the fluid of choice for initial resuscitation and subsequent intravascular volume replacement in critically ill patients 2, 3

• Voluven is associated with significant risks:

  • Increased need for renal replacement therapy 4, 5
  • Impaired kidney function 4
  • Coagulation disorders and increased risk of bleeding 5
  • Tissue storage and accumulation with repeated doses 6

• Voluven should not be used in:

  • Patients with sepsis 2, 3
  • Patients with pre-existing renal impairment 4
  • Patients with coagulopathy or at risk for bleeding 5

Administration Technique

• Use sterile equipment for administration 1
• Replace intravenous administration apparatus at least once every 24 hours 1
• For single use only - the solution contains no bacteriostat or antimicrobial agents 1
• When smaller doses are required, discard the unused portion 1

Important Precautions

• The common belief that 3-4 times more crystalloid than colloid volume is needed for similar hemodynamic effects is overestimated; actual ratios are closer to 1.8:1 7

• Monitor patients for adverse reactions including:

  • Signs of kidney injury 4
  • Bleeding complications 5
  • Pruritus and skin rash, which are common adverse events 8

• Do not mix Voluven with other medications in the same IV line without confirming compatibility 1

• When citrate is used as an anticoagulant with Voluven, the admixture is compatible for 24 hours at room temperature 1

Clinical Monitoring During Administration

• Monitor vital signs, urine output, and hemodynamic parameters during administration 8
• Continue fluid administration only as long as hemodynamic improvement is observed 2, 3
• Be vigilant for signs of fluid overload, especially in patients with cardiac or renal compromise 8

Remember that despite the availability of Voluven, current evidence strongly suggests that crystalloids should be the first choice for fluid resuscitation in most clinical scenarios 2, 3.