In this section
This document guides how to prescribe, order, administer and manage patients receiving intravenous albumin at the RCH
Albumin is manufactured from human plasma. It is a clear,
slightly viscous liquid that is almost colourless, but may have a yellow, amber
or slightly green discolouration.
Albumin accounts for more than half of the total protein in
plasma and represents about 10% of the protein synthesis activity of the liver.
Albumin comes in two concentrations: Albumex® 4 (4%) and
Albumex® 20 (20%)
Iso-oncotic with human serum and isotonic
Hyper-oncotic and hypo-osmotic compared to human serum
of plasma colloid osmotic pressure and carriage of intermediated products in
the transport and exchange of tissue metabolites.
of plasma colloid osmotic pressure and carriage of intermediate products in the
transport and 3exchange of tissue metabolites.
in hypovolaemic or intravascularly deplete patients
in patients with fluid or sodium restrictions (e.g. patients with
hypoproteinaemia or generalised oedema)
1g/kg/dose depending on indication
5 minutes to 2 hours depending on indication
– 1g/kg/hour depending on indication
with extreme caution in preterm neonates, due to the risk of IVH.
12.5 – 25 mL/kg
Frank Shann information
Albumin is a plasma-derived blood product. Consent must
be documented on the Patient consent to blood products
MR634/A form prior to administration.
The concentration (4% or 20%), dose/volume, route,
frequency and duration of infusion must be prescribed.
Albumin may be prescribed as a bolus dose, where a
patient requires an Albumin infusion over a discrete period of time and the
total dose is known.
A continuous infusion is sometimes used when a patient
needs an Albumin infusion for an extended period of time and when the clinician
does not know exactly when the infusion will cease. In this instance it should
be prescribed as a regular administration e.g. every 6 hours.
must independently complete the patient and blood product identification check
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
displayed on the identification band and the order/prescription.
Check the order/prescription to ensure the following:
Check the blood product:
Record the batch number and expiry date of each bottled infused in the
medical record. Staff administering Albumin must also record the date, time
and volume infused.
Administer via a standard intravenous (IV) giving set. It
does not require a transfusion filter.
Albumin is packed in a glass bottle and must be vented
recommends that each bottle of Albumin is used immediately after opening the
bottle as it does not contain antimicrobial preservative. At RCH we allow the
product to be administered within 6 hours of piercing the bottle.
Refer to the EMR tips sheets for details on how to accurately document Albumin in the Electronic Medical Record (EMR)
heart rate, respiration rate, blood pressure and SpO2 should be recorded at
baseline, hourly, at every change in bottle and upon completion. More frequent observations as the clinical
condition of the patient requires.
Adverse reactions to albumin solutions are usually mild
Mild reactions such as mild hypotension, flushing,
urticaria, fever and nausea usually disappear when the infusion rate is slowed
Very rarely, severe allergic reactions such as
anaphylaxis or significant hypotension can occur. The infusion should be
stopped and appropriate treatment initiated (IV fluids for hypotension and IM
adrenaline for anaphylaxis).
Due to the colloid osmotic effect of Albumin 20%, patient
should be monitored for circulatory overload.
The risk of viral transmission for albumin products is
extremely low. Plasma donors undergo screening and products are tested for the
presence of viral antigen.
During the manufacture process, there are viral
inactivation and pathogen reduction strategies to minimise further the risk of
viral transmission. Despite these measures, such products may still potentially
transmit viral infection and theoretically Creutzfeldt-Jakob Disease.