Albumin Administration

  • This document guides how to prescribe, order, administer and manage patients receiving intravenous albumin at the RCH

    Refer to the EMR tip sheet for further information

    Albumin indication and dosing


    Albumin usually has a clear to pale yellow colour but may occasionally have a green discolouration which is attributed to small amounts of the degradation products of bilirubin, biliverdin and lumirubin,

    Bilirubin is a by-product of the breakdown of haemoglobin which occurs when red cells reach the end of their life span. Albumin is the protein responsible for transporting the bilirubin to the liver where the bilirubin is conjugated and excreted via the bile ducts. Albumin is an essential component in maintaining fluid balance within the body.

    Albumin comes in two concentrations:

    1. 4% Albumex is a 4% protein solution, which is iso-osmotic with human serum.  It comes in two sizes 2g human albumin in 50ml or 20g human albumin in 500mls.
    2. 20% Albumex ia a 20% protein solution, which is hyper-osmotic with human serum.  It comes in two sizes 2g human albumin in 10mls and 20g human albumin in 100mls.

    Clinical indications for the use of albumin

    4% Albumin is commonly administered for the following conditions:

    • Shock associated with significant hypoalbuminaemia
    • Therapeutic plasma exchange
    • Cardiothoracic surgery, to prime the pump in patients with poor left ventricular function and other complicating factors.
    • Replacing drainage losses 

    20% Albumin is commonly administered for the following conditions:

    • Extremely low albumin in critically-ill patients
    • Burns
    • Paracentesis of ascites in patients with cirrhosis or when the volume exceeds 6L.
    • Haemodialysis 

    Ordering albumin - 'Prepare' and 'transfuse'

    Albumin can be ordered in EMR either as a continuous infusion or a bolus dose.

    A bolus dose is to be ordered for those patients requiring an albumin infusion over a discrete period of time when the total dose is already known.

    The continuous infusion is to be used for those patients who are on albumin infusions for an extended period of time when the clinician does not know the exact time the infusion will cease and potentially may not know the exact volume required (ie: The order may specify replace drain losses in a 1:2 ratio). The order will need to be completed for a certain period of time, but this can be modified or discontinued as needed. 

    The ordering clinician will need to complete the prepare and transfuse order in the blood order set in EMR. The ‘transfuse and prepare’ orders should only be completed if there is an intention to transfuse. These steps are outlined below. 

    The ‘prepare’ and ‘transfuse’ orders are the responsibility of the medical practitioner. It is the authorisation for blood bank to prepare the albumin and for clinical staff to administer it.

    Upon opening the order set, the observations will need to be selected to be specific to the albumin infusion. The order for albumin is located under the batched products section of the order set. Once you have selected the type of infusion required, the prepare and transfuse orders can be completed. Transfuse will come up first in the batched products. 


    The transfuse order for a bolus includes:

    • Date and time of transfusion
    • Concentration of albumin
    • Dose in mls 
    • Rate of administration
    • Clinical notes - complete this section with an indication for transfusion or any other relevant information.

    The prepare order is automatically populates with the information from the transfuse order. 


    To order a continuous infusion, the process is the same however the frequency will need to be completed. It will automatically populate with 10 occurrences. This will allow the nursing staff to print out 10 release forms to collect product 10 times. If there is the intention for more or less, this should be indicated in the frequency section. This order can be modified at any point of the patient stay, but must be discontinued when the requirements for a continuous infusion change. 

    Emergency albumin stock

    In critical care areas, there is a provision in place to allow for emergency stock to be released from blood bank.

    To order emergency stock, complete the form which came with the emergency bottle and return it to blood bank. An emergency bottle will then be released to replace the one which was used. Patient details must be present to allow for this to happen. 

    For all orders, the prescriber is responsible for ensuring: 

    • transfusion is clinically appropriate and the reason for transfusion documented
    • expected benefits outweigh potential hazards
    • clinical staff have been informed of the prescription


    Albumex should be administered through a standard IV giving set (no filter required).  As Albumex has no antimicrobial properties or additives the manufacturer recommends that the vial is used within 4 hours of spiking the bottle. Australian Red Cross Blood Service ARCBS recommends that each bottle of Albumex is used within 4 hours.

    The administration of albumin in EMR does not activate the BPAM module. Documentation of albumin administration should still be completed in the blood tab in flowsheets and the same checking procedure should occur. The order will not appear in the flowsheets however so the administrator must refer back to the order section for the appropriate concentration, dose and rate.

    Two clinicians must independently complete the patient and blood product identification check at the bedside. By electronically signing the blood administration flowsheet checks in EMR they indicate they have correctly completed this process.

    • At the bedside, if possible ask the patient or parent/guardian to state full name and birth.
    • Check these details match exactly on and include the MRN:
      • 1.Identification band
      • 2.EMR order
    • In EMR:
      • Complete pre-transfusion documentation
      • Select the action row and choose “new bag”
      • Specify the concentration of the albumin you are administering
      • Specify rate of administration the infusion will be commenced at
      • Record the last three digits of the batch number on the bottle you have received
    • Check the order to ensure the following:
      • The albumin ordered matches what you have received
      • Duration per bottle is specified and appropriate. Clarify this with ordering physician if not specified
      • Dose to be transfused
      • Transfusion consent present
      • Previous alert for transfusion reaction
    • Check the blood product:
      • Expiry date
      • Integrity of the albumin
    • Co-sign to indicate the 2nd user has independently completed the above checks

    The above process is the same for a continuous infusions however the rate of infusion may not be indicated as a number, but as a replacement regime based on patient losses.

    A continuous infusion order will generate 10 separate release events. Each release should be activated every time albumin is retrieved from the blood bank. Each release form can be used for as many bottles of albumin that will be required. This number just needs to be recorded on the release form. 


    Temperature, SpO2, heart rate, respiration rate and blood pressure should be recorded at baseline, hourly, every change in bottle, upon completion and 4 hourly for 24 hours (inpatients) for patients receiving a one off dose of albumin.

    Temperature, SpO2, heart rate, respiration rate and blood pressure should be recorded at baseline, at change of bottle and then as frequently as the clinical condition of the patient requires for the remainder of the albumin infusion if they are receiving a continuous albumin infusion.