In this section
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 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:
4% Albumin is commonly administered for the following
20% Albumin is commonly administered for the following
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
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:
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.
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:
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.
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