dextranomer
dextranomer
[dek-stran´o-mer]dextranomer/hyaluronate
(dex-tran-oh-mer/ hy-al-yoor-on-ate),Solesta
(trade name)Classification
Therapeutic: temporary classPharmacologic: temporary class
Indications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile
ROUTE | ONSET | PEAK | DURATION |
---|---|---|---|
rectal submucosal injection | within days | within days-mos | 12 mos or more |
Contraindications/Precautions
Adverse Reactions/Side Effects
Gastrointestinal
- constipation
- defecation urgency
- diarrhea
- painful defecation
Genitourinary
- dyspareunia
Local
- proctalgia (most frequent)
- anal fissure
- anal hemorrhage
- anal prolapse
- anal pruritus
- anorectal discomfort
- injection site hemorrhage
- injection site pain
- proctitis
- rectal abscess
- rectal discharge
Miscellaneous
- chills
- fever
Interactions
Drug-Drug interaction
None noted.Route/Dosage
Availability
Nursing implications
Nursing assessment
- Assess frequency of fecal incontinence before and after therapy.
Potential Nursing Diagnoses
Diarrhea (Indications)Implementation
- Dextranomer hyaluronate should only be administered by physicians experienced in performing anorectal procedures and having successfully completed a comprehensive training and certification program in injection procedure.
- Injections are made in midline of anterior wall of rectum. Use a new needle and syringe with each injection. Hold needle at injection site for additional 15–30 seconds to minimize leakage. May require repeated injections. Avoid in men with enlarged prostate.
- Do not inject IV; may cause vascular occlusion.
- Pre-treatment—evacuate rectum with an enema immediately prior injection. Follow by cleansing area with antiseptic. Prophylactic antibiotics are recommended.
Patient/Family Teaching
- Explain purpose and procedure to patient.
- Inform patient that dextranomer hyaluronate is not effective for all patients with fecal incontinence and repeat treatment may be required for treatment effect.
- Explain post-treatment care and potential adverse events to patient.
- Advise patient that implants might be detected during future anorectal examinations and radiographic imaging of pelvis. Instruct patient to inform all future treating physicians about presence of Solesta gel. If future surgery (e.g., hemorrhoidectomy) is needed Solesta implant can be resected.
Evaluation/Desired Outcomes
- Fewer episodes of fecal incontinence.