Experience with Haemaccel?

[DwayneEMTP]

Hey all,

I've got Haemaccel in my jump bag here in PNG. I've not used it, or even heard of it before to tell the truth. Due to the dorky spelling I'm thinking that this may be used by the Aussies or Kiwis....

Some Googling would lead on to believe that it's only significant advantage is that much slower elimination than NS would mean that it would be eliminated slow so smaller volumes would/could be used.

Am I missing the point here? Do you have any experience with it? When would you choose it over NS?

Thanks for any help that you can provide. And I wouldn't be opposed to the physics/pharmacokinetics/physiology lessons that may be attached.

[Kiwiology]

Haemaccel is an intravenous colloid which in theory should be better than normal saline or any other like fluid e.g. ringers lactate which are crystalloids; however the evidence does not seem to support this view conclusively if I understand correctly.

A colloid and a crystalloid are different in that the colloid contains large particles which do not dissolve and exert a pressure (oncotic pressure) whereas a crystalloid does not. Remember the old addage that only about 1/3 of your infused saline will remain in the intravascular space? that is because the crystalloid fluid will diffuse out across the vascular membrane but this does not happen with a colloid because the particles are too large.

This is best explained by the answer I wrote in Paramedic (ICO) Assignment # 5 back in 2009

A near equilibrium exists at the capillary membrane; that the amount of fluid leaving the arteriole end of the capillary is almost exactly the same as the amount returned by absorption. A small difference of 0.3mmHg does exist because of the fluid drained into lymphatic circulation. Total mean force moving fluid outward is 28mmHg while total mean force moving fluid back inward is 28.3mmHg and the difference (0.3mmHg) is the net filtrate which must be reabsorbed into lymphatic circulation. The effect of reduced capillary circulation (hypovolaemia) is that reabsorption will be increased at the expense of interstitial fluid volume.A near equilibrium exists at the capillary membrane; that the amount of fluid leaving the arteriole end of the capillary is almost exactly the same as the amount returned by absorption. A small difference of 0.3mmHg does exist because of the fluid drained into lymphatic circulation. Total mean force moving fluid outward is 28mmHg while total mean force moving fluid back inward is 28.3mmHg and the difference (0.3mmHg) is the net filtrate which must be reabsorbed into lymphatic circulation. The effect of reduced capillary circulation (hypovolaemia) is that reabsorption will be increased at the expense of interstitial fluid volume.

Hydrostatic pressure is the pressure exerted against the wall by the fluid inside and acts to push fluid out into the interstitial space

Colloid osmotic pressure (oncotic pressure) is the pressure that opposes hydrostatic pressure and is exerted by large non-permeable substances such as plasma proteins acting to pull water back into the vasculature

No we do not use it nor do we plan to

[chbare]

Dwayne it has similar effects to something that you may have run across in Afghanistan called Hextend. Hextend is simply hetastarch in a Ringer's lactate solution.

The chemical differences are complex, but I'll give you the readers digest version:

Haemaccel is a Urea linked gelatin molecule. Think boiled proteins.

Hetastarch is a polysaccharide molecule. Think complex carbohydrates.

They essentially do the same thing but have different metabolic pathways and side effect profiles. I believe anaphylactiod reactions are more common with gelatins.