Preparing for Albumin Infusion
Before you infuse albumin, a number of preparation steps are required to ensure patient safety and proper administration. All steps must be followed according to institutional protocols. First, gather all necessary supplies, including the prescribed concentration of albumin, a standard intravenous (IV) giving set, a vented spike (if using a glass bottle), saline flushes, gloves, and an IV pump. Confirm the patient's identity and that the prescription matches the product, including concentration (e.g., 5% or 20%), dose, and infusion rate.
Next, perform hand hygiene and don sterile gloves. Inspect the albumin solution for any signs of cloudiness, deposits, or discoloration, and verify the expiry date. The product should be a clear, slightly amber or green liquid; if it appears otherwise, discard it immediately. Allow the solution to reach room temperature before administration to improve flow, especially for larger volumes. For patients with specific needs, such as sodium restriction, confirm the appropriate diluent (e.g., 5% Dextrose in Water instead of normal saline).
Step-by-Step Administration Process
Administering albumin involves several critical steps to ensure a smooth and safe procedure. This process should only be carried out by a trained healthcare professional, as serious complications can arise from incorrect administration.
- Patient Verification and Assessment: Conduct a double-check of the patient's identification and the prescription order with another healthcare professional. Perform a baseline assessment, including vital signs (blood pressure, pulse, respiratory rate), skin condition, and fluid status.
- Establish IV Access: Ensure a patent intravenous line is in place. Flush the IV catheter with a saline solution to check for patency and clear any residual medication.
- Prime the IV Set: If using a glass bottle, insert a vented spike into the container. Close the roller clamp, hang the bottle, and fill the drip chamber two-thirds full. Slowly open the roller clamp to prime the tubing, ensuring no air bubbles remain. If using a flexible bag, a standard IV set is sufficient and does not require venting.
- Connect and Initiate Infusion: Connect the IV tubing to the patient's IV access point. Secure the connection and initiate the infusion via the IV pump at the prescribed rate. The infusion rate depends on the concentration and indication. For example, 25% albumin is often administered slower than 5% to prevent circulatory overload.
- Monitoring During Infusion: Continue monitoring the patient's vital signs and clinical status. Pay close attention to signs of volume overload, such as dyspnea, increased blood pressure, or jugular vein distention.
- Complete and Discontinue: When the infusion is complete, clamp the line, disconnect it from the patient, and flush the IV catheter with saline to maintain patency. Record the administration in the patient's medical record, including the batch number and expiry date.
Comparison of Albumin Concentrations
Different clinical scenarios require different albumin concentrations. Understanding the distinction is crucial for proper patient management.
| Feature | 5% Albumin (Iso-oncotic) | 20-25% Albumin (Hyper-oncotic) |
|---|---|---|
| Effect | Expands circulating plasma volume slowly, similar to plasma. | Rapidly increases plasma volume by drawing fluid from extravascular spaces. |
| Indications | Used primarily for volume expansion in hypovolemia or shock. | Used for conditions requiring fluid restriction, like cirrhosis with ascites, adult respiratory distress syndrome, and hypoalbuminemia. |
| Administration Rate | May be infused more rapidly, especially in shock. | Administered slowly and carefully to prevent circulatory overload. |
| Monitoring Focus | Primarily focused on restoring blood volume and pressure. | Intense monitoring for signs of fluid overload, electrolytes, and renal function. |
| Associated Fluids | Can be diluted with 0.9% NaCl or 5% Dextrose. | Can be given undiluted or diluted in 0.9% NaCl. Do not dilute with sterile water. |
Indications for Albumin Infusion
Albumin is used in a variety of clinical situations, based on its ability to increase circulating blood volume and maintain plasma oncotic pressure. Key indications include:
- Hypovolemia and Shock: In cases of low blood volume from conditions like trauma or surgery, albumin can be used to restore circulating blood volume and stabilize hemodynamics.
- Hypoalbuminemia: For severe deficiencies of albumin caused by conditions like malnutrition, infections, burns, or liver disease, infusions help normalize protein levels.
- Cirrhosis and Ascites: Albumin is administered after large-volume paracentesis (>5 liters) to prevent paracentesis-induced circulatory dysfunction and improve patient outcomes.
- Spontaneous Bacterial Peritonitis (SBP): As an adjunct to antibiotics, albumin reduces the risk of renal impairment and mortality in patients with cirrhosis and SBP.
- Adult Respiratory Distress Syndrome (ARDS): In conjunction with diuretics, albumin can help mobilize interstitial pulmonary edema in certain ARDS patients.
- Ovarian Hyperstimulation Syndrome (OHSS): Used to treat volume shifts and maintain hemodynamic stability in severe cases.
Patient Monitoring and Post-Infusion Care
Close monitoring is essential throughout the infusion process and afterward to manage potential adverse effects. During infusion, monitor for signs of circulatory overload such as headache, dyspnea, increased blood pressure, or jugular venous distention. Allergic reactions, though rare, can occur and manifest as skin rash, hives, flushing, fever, or even anaphylaxis. Mild reactions may subside by slowing the infusion rate, while severe reactions require immediate cessation and emergency treatment.
Electrolyte status, hemoglobin, and hematocrit should be monitored, especially after large-volume infusions, as hemodilution can occur. Regular assessment of central venous pressure, urine output, and overall fluid balance helps guide therapy and prevent complications. Post-infusion, continue to observe the patient for any delayed reactions and ensure stable vital signs. Document the complete procedure, including patient response and any adverse events. Proper disposal of unused product is also required.
Conclusion
Administering albumin is a complex medical procedure that requires a thorough understanding of the product, strict adherence to protocol, and attentive patient monitoring. From careful pre-infusion checks to continuous observation during and after the infusion, every step is critical for patient safety. The choice of albumin concentration, rate of administration, and adjunctive treatments all depend on the specific clinical indication. By following established guidelines and exercising caution, healthcare professionals can effectively manage conditions like hypovolemia and hypoalbuminemia while minimizing potential risks, ensuring optimal outcomes for their patients. Adherence to these best practices is paramount for safe and effective albumin therapy.
