Human albumin is the most abundant protein in human blood plasma, produced exclusively by the liver. Its primary function is maintaining colloidal osmotic pressure, which helps keep fluid within blood vessels and stabilizes circulating blood volume. Albumin is commonly administered in hospital settings to treat hypovolemia and hypoalbuminemia, often seen in patients with severe burns, liver disease, or those undergoing surgery. It also functions as a carrier protein, transporting various substances, including hormones, fatty acids, and certain medications.
Preparation: Essential Safety Verification
Before administering an intravenous albumin infusion, a safety verification process ensures patient safety. First, confirm the patient’s identity using at least two identifiers, such as name and date of birth, and cross-reference this with the physician’s order. The order must specify the correct concentration (typically 5% or 25%), the prescribed dose, and the designated infusion rate and duration.
The albumin product requires careful inspection before preparation. Check that the expiration date is current and the solution appears clear, possibly with a slight yellow or greenish tint, but never cloudy or containing visible particles. Since albumin is a blood product, strict handling protocols are necessary. Gather all equipment, including the albumin container, a standard intravenous administration set, an infusion pump, and sterile preparation supplies, at the bedside.
Initiating the Infusion: Connecting and Starting the Flow
Setting up the infusion begins with preparing the administration set after safety checks are complete. Close the roller clamp on the IV tubing, remove the protective cap from the spike, and insert it firmly into the albumin container port. If using a glass bottle, a vented administration set or an air inlet needle must be used to prevent a vacuum and ensure fluid flow.
Partially fill the drip chamber, approximately halfway, by gently squeezing it after spiking the container. Prime the tubing by slowly opening the roller clamp, allowing the albumin solution to flow through the entire length of the set to push all air out. Keep the tubing’s distal tip sterile and attach it to the patient’s existing compatible intravenous access point.
The final step is setting the correct infusion rate using an electronic infusion pump for precise control. Program the prescribed rate, measured in milliliters per hour, into the pump to deliver the dose over the ordered time. For concentrated 25% albumin, the rate is often restricted to a slower pace, usually not exceeding 1 to 2 milliliters per minute. This slower rate prevents a sudden increase in plasma volume that could overwhelm the circulatory system due to its hyperosmotic nature.
Patient Monitoring and Managing Potential Reactions
Continuous patient monitoring begins with obtaining baseline vital signs before the infusion starts. Because albumin pulls fluid into the bloodstream, close observation for signs of fluid overload is necessary, particularly in patients with pre-existing heart or kidney issues. Providers monitor for symptoms like shortness of breath, increased blood pressure, or a rise in heart rate, which can indicate circulatory overload or pulmonary edema.
Vital signs are typically re-checked hourly throughout the administration. Patients should also be monitored for acute infusion reactions, which are usually mild but can rarely be severe. These reactions may present as flushing, fever, chills, mild hypotension, or a skin rash, and usually resolve if the infusion rate is slowed or temporarily stopped.
If a more serious reaction, such as anaphylaxis, occurs, the infusion must be immediately discontinued, and emergency protocols initiated. The patient’s physiological response is continuously assessed, and urine output is tracked as an indicator of adequate kidney function and fluid management. After the infusion is complete, the IV line is flushed with a compatible solution, and monitoring continues to confirm patient stability.