Albumin Administration

  • 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/kg15 to 20 minutes
     Hypovolaemic shock in children 0.5 g – 1 g/kg12.5 - 25 mL/kg
    5 - 10 minutes
     Hypoproteinaemia 0.5g – 1 g/kg12.5 – 25 mL/kg2 - 4 hours
     Large volume paracentesis 0.5g – 1 g/kg12.5 – 25 mL/kg1 - 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.