Albumin (human) prescription and administration guideline
This document guides how to prescribe, order, administer and manage patients receiving intravenous albumin at the RCH
Description
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%)
Albumin formulations
Preparation | Albumin 4% (40 g/L) | Albumin 20% (200 g/L) |
Concentration |
1g
human albumin/25ml |
1g
human albumin/5mls |
Description |
Iso-oncotic with human serum and isotonic |
Hyper-oncotic and hypo-osmotic compared to human serum |
Function |
Maintenance
of plasma colloid osmotic pressure and carriage of intermediated products in
the transport and exchange of tissue metabolites. |
Maintenance
of plasma colloid osmotic pressure and carriage of intermediate products in the
transport and 3exchange of tissue metabolites. |
Vial size |
2g
human albumin/50ml
20g
human albumin/500ml
|
2g
human albumin/10mls
20g human albumin/100mls |
Note |
Use
in hypovolaemic or intravascularly deplete patients |
Use
in patients with fluid or sodium restrictions (e.g. patients with
hypoproteinaemia or generalised oedema) |
Dose |
0.5 –
1g/kg/dose depending on indication
Older child 250 –
500 ml/dose | 0.5
– 1g/kg/dose depending on indication |
Infusion rate |
Between
5 minutes to 2 hours depending on indication |
0.25
– 1g/kg/hour depending on indication |
Caution | |
Use
with extreme caution in preterm neonates, due to the risk of IVH. |
4% Albumin
Clinical indications for the use of 4% Albumin
- Fluid resuscitation (should not be used as first
line treatment – use crystalloids first)
- Significant hypoalbuminemia
- Nephrotic syndrome
- Therapeutic plasma exchange
- Cardiothoracic surgery as a pump prime for
cardiopulmonary bypass
- Excessive protein losses/replacement of drain losses
- Burns fluid replacement
- Liver transplant post-operative management
- Post cardiac surgery chylothorax management
4% Albumin dosing and infusion guide
| Dose (g) | Dose (ml) | Infusion duration guide |
Hypovolaemia, plasma volume expansion in
children | 0.5 g
– 1g/kg |
12.5 – 25 mL/kg
Older child - 250 mL – 500 mL | 30 - 60 minutes (slower rates in neonates)
|
Hypotension | 0.5 g/kg | 12.5 mL/kg | 15 to 20 minutes |
Hypovolaemic shock in children | 0.5 g
– 1 g/kg | 12.5 - 25 mL/kg
| 5 - 10 minutes |
Hypoproteinaemia | 0.5g
– 1 g/kg | 12.5
– 25 mL/kg | 2 - 4 hours
|
Large volume paracentesis | 0.5g – 1 g/kg | 12.5 – 25 mL/kg | 1 - 2 hours after paracentesis
|
20% Albumin
Clincial indications for the use of 20% Albumin
- Patients with significant hypoalbuminaemia
- Nephrotic syndrome
- Ascites in patients with severe liver disease
- Resuscitation of patients in shock due to acute loss of blood or plasma, although 4% albumin is preferred
- Plasmapheresis when a patient’s serum albumin is not maintained with albumin 4% solution
- Haemolytic disease of the fetus and newborn
- Liver failure
- Post-operative liver transplant management
- Use with caution in preterm neonates due to risk of intraventricular haemorrhage.
20% Albumin dosing and infusion guide
| Dose (g) | Infusion duration guide |
Haemolytic disease of the
fetus and newborn | 1 g/kg/dose | Prior
to or during plasma exchange |
Large volume paracetensesis | 0.5
– 1 g/kg | Over
1-2 hours after paracentesis |
Ascites with
hypoalbuminaemia | 1 g/kg/dose | Over
2- 3 hours |
Nephrotic syndrome,
refractory | 0.5
– 1 g/kg | Over
30 – 60 minutes followed by diuretics |
Frank Shann information
- 20% Albumin 2-5 mL/kg
- 4% Albumin 10 – 20 mL/kg
- If
no loss from plasma: dose (ml/kg) = 5x (increase g/L) / (%albumin)
Ordering and administration
Consent
Albumin is a plasma-derived blood product. Consent must
be documented on the Patient consent to blood products
MR634/A form prior to administration.
Prescription/order
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.
Administration and documentation
Two clinicians
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:
- Albumin ordered/prescribed
matches the product you have received from blood bank (e.g. 4% Albumin vs
20% Albumin)
- Dose/volume and duration per
bottle is specified and appropriate
- Consent for blood product
transfusion is present
- Previous alert for transfusion
reaction
Check the blood product:
- Expiry date
- Integrity of the albumin
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
during use.
The manufacturer
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.
EMR and Albumin documentation
Refer to the EMR tips sheets for details on how to accurately document Albumin in the Electronic Medical Record (EMR)
Observations
Temperature,
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.
Reactions
Adverse reactions to albumin solutions are usually mild
and transient.
Mild reactions such as mild hypotension, flushing,
urticaria, fever and nausea usually disappear when the infusion rate is slowed
or ceased.
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.
Pathogen safety
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.