Paediatric Albumin Guidance
This document guides how to prescribe, administer and manage paediatric patients receiving intravenous albumin at the RCH.
Albumin comes in two concentrations: Alburex®5 (5%) and Alburex®20 (20%).
Preparation Alburex 5% (50 g/L) Alburex 20% (200 g/L) Concentration 1g human albumin/20ml 1g human albumin/5mls Description Mildly hypo-oncotic Hyper-oncotic and hypo-osmotic * Vial size
- 12.5g human albumin/250mL vial
- 25g human albumin/500mL vial
- 2g human albumin/10mls
- 20g human albumin/100mls
Use Use in hypovolaemic or intravascularly deplete patients Use in patients with fluid or sodium restrictions Contraindication Patients with history of anaphylaxis to albumin or constituents Caution The minimum vial size has changed from 50mL to 250mL Extreme caution in preterm neonates, due to intraventricular haemorrhage risk. Children with precarious fluid balance status *
*Alburex 20% is both hyper-oncotic and hypo-osmotic compared with Albumex 20% (only hyper-oncotic). Therefore, there is higher risk of acute fluid shifts between physiological compartments.
Additional details on comparisons between Alburex 20% and Albumex 20%.
Indications, dosing and infusion rates
5% Albumin
5% Albumin clinical indications
Fluid resuscitation (not first line – use crystalloids) Significant hypoalbuminemia Nephrotic syndrome Therapeutic plasma exchange Cardiopulmonary bypass pump prime Excessive protein losses/replacement of drain losses Burns fluid management Liver transplant post-operative management Post cardiac surgery chylothorax management
5% Albumin dosing and infusion guide for children
Dose (g) Dose (mL) Infusion duration guide Hypotension 0.5 g/kg 10 mL/kg 15 to 20 minutes Hypovolaemia, plasma volume expansion 0.5 g – 1g/kg
10 – 20 mL/kg
Older child 250 to 500 mL
30 – 60 minutes (slower rates in neonates) Hypovolaemic shock 0.5 g – 1 g/kg 10 – 20 mL/kg 5 – 10 minutes Hypoproteinaemia 0.5g – 1 g/kg 10 – 20 mL/kg 2 – 4 hours Large volume paracentesis 0.5g – 1 g/kg 10 – 20 mL/kg Over 1 – 2 hours after paracentesis
20% Albumin
20% Albumin clinical indications
Nephrotic syndrome Children with severe liver disease and ascites Liver failure Plasmapheresis when a patient’s albumin is not maintained with 5% albumin solution Haemolytic disease of the fetus and newborn Children with significant chylothorax Post-operative liver transplant management
20% Albumin dosing and infusion guide in children
Dose (g) Infusion duration guide* Nephrotic syndrome, refractory 0.5 – 1 g/kg Over 30 – 60 minutes followed by diuretics Large volume paracetensesis 0.5 – 1 g/kg Over 1-2 hours after paracentesis Haemolytic disease of the fetus and newborn 1 g/kg/dose Prior to or during plasma exchange Ascites with hypoalbuminaemia 1 g/kg/dose Over 2- 3 hours
* Caution – too rapid administration can result in vascular overload.
Consent, prescription, administration, reactions and adverse events
Consent and patient information
- Albumin is a plasma-derived blood product. The risk of viral transmission is exceptionally low.
- Consent must be documented on the Patient consent to blood products MR634/A form prior to administration.
- CSL Consumer Medicine information:
- Alburex 5%
- Alburex 20%
Prescription
Prescription / order must contain: – Concentration (5% or 20%) – Dose (g) / volume (mL) – Route (IV) – Frequency (stat / bolus) or recurrent bolus* – Duration of infusion (maximum 6 hours) *
* Albumin may be prescribed as a bolus dose or a continuous infusion (in this instance it should be prescribed as a regular administration (e.g., every 6 hours)
Administration
Pre-infusion Two staff perform double independent checks of patient, product and prescription at the patient bedside. This includes: – Correct product and concentration (5% vs 20%) – Dose / volume and rate specified and appropriate for patient. – Expiry date – Integrity of the product – Dual sign and record the batch number and expiry date of each bottle infused in medical record. Other administration considerations
– Albumin does not contain any antimicrobial preservative. The manufacturer recommends that each bottle be used immediately after opening.
– At RCH we allow the product to be administered within 6 hours of piercing the bottle.
– Administer via a standard intravenous (IV) giving set. It does not require a transfusion filter. – Must be vented during infusion. – Use an infusion pump with careful consideration of rate and total volume to be infused to prevent over infusion. – Caution – the minimum vial size has changed from 50 to 250 mL. – Albumin is a clear liquid that may have a yellow or slight green tinge. – If cloudy or noted to have precipitation return to blood bank.
– Do not mix with any medications.
– Albumin may be infused with red cells and ABO compatible plasma.
– Do not be dilute with water for injections, this may cause haemolysis. – Return to blood bank immediately if no longer required. – Any unused product must be discarded. – Do not place in ward drug fridges or allow to remain at patient’s bedside.
Observations and monitoring
Carefully monitor the patient for circulatory overload, especially in relation to Alburex 20% due to the colloid osmotic effect. Minimum observations include:
Time point Observations Baseline Temperature, pulse, respiratory rate, blood pressure, SaO2 Hourly until transfusion is completed Temperature, pulse, respiratory rate, blood pressure, SaO2 and IV pump volume/volume infused. Conclusion
Reactions, adverse events and near misses
- 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. In these instances, the albumin infusion should be stopped and appropriate emergency treatment provided (IM adrenaline for anaphylaxis and IV fluids for hypotension).
- Manage and report reactions as per the Blood Transfusion – Fresh Blood Products Procedure
- Report any adverse events or near miss via VHIMS.