Introduction
Human albumin is available in the following strengths and sizes (Rationale 1 and 2):
Strengths and sizes of albumin available | Strength | Size |
| 4.5% | 50mls 100mls 250mls 500mls |
| 20% | 50mls 100mls |
Uses of human albumin:
It is particularly used for children who have:
Preparation
Child and family
Inform child and family of the following (Rationale 7):
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that an infusion is necessary
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the reason for the infusion
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what it entails
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the likely duration of the procedure
Supply child and their parents with the appropriate information leaflet obtainable from Blood Bank and the Family Resource Centre (Rationale 8).
Ensure the following normal or pre-infusion observations of the child are known (Rationale 9, 10 and 11):
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temperature
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respiration rate
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heart rate
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blood pressure
Ensure venous access has been established (Rationale 12).
This should be according to intravenous infusion guidelines.
Prescription
Blood products MUST NOT be administered unless prescribed on the child’s prescription chart (Pink Transfusion chart) as Human Albumin. No abbreviations will be accepted (Rationale 13).
For electronic prescribing areas, it should be prescribed electronically as well as on the pink transfusion chart.
Ensure the blood product is prescribed according to the Drug Policy. The strength of the solution must be included (Rationale 13).
The volume should be in mls not units (Rationale 14).
Ensure it is prescribed correctly including:
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infusion time should be three hours or less but needs to be in accordance with the manufacturer's recommendations (Rationale 15)
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for infusions longer than three hours, please refer to Pharmacy
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the infusion rate is suitable for the size of child (Rationale 14)
Ensure there is sufficient human albumin solution of the correct strength supplied to meet the prescription requirements (Rationale 16).
Ensure you have a prescription or instructions for what should happen after the infusion (Rationale 17).
Infusion
Collect required albumin from the Pharmacy; this will include a Red Tag with patient name, hospital and batch number (Rationale 18).
For areas with ‘ward stocks’ (Eagle, Haemodialysis, Fox, PICU/NICU), these are to be used in emergency/out-of-hours only (Rationale 19).
Ward stock should be protected from light (ie in its original box) and stored at less than 25°C (Rationale 20).
Check albumin is free from cloudiness and/or precipitate (Rationale 21). IF PRESENT DO NOT USE (Rationale 22).
Gather the equipment required for intravenous infusions.
An Intravenous Solution Administration Set should be used (Rationale 23).
Prime Intravenous Solution Administration Set with albumin using standard (universal) precautions and an aseptic non-touch technique (Rationale 24, 25 and 26).
Albumin should not be mixed with other medicinal products, whole blood or packed red cells (Rationale 27).
Infusion
General
Check the child’s identity band, product label, Red Tag and prescription according to the Drug Policy (Rationale 28).
Connect prepared albumin to the child according to relevant intravenous therapy guidelines using an aseptic non-touch technique (Rationale 29 and 30).
Set infusion rate according to prescription BUT ensure infusion is completed within three hours or according to the manufacturers instructions/Pharmacy guidance (Rationale 30 and 31).
The Intravenous Solution Administration Set may need flushing with 0.9% sodium chloride to ensure the total amount of albumin prescribed is infused (Rationale 32).
Give diuretic if prescribed at required time according to the Drug Policy (Rationale 29 and 33).
Observations and recordings
Do not leave the child unattended for the first thirty minutes of the infusion (Rationale 34).
This should be negotiated with any family members in attendance.
Record the following on the Pink Transfusion Chart:
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the batch of the albumin (using manufacturers’ peel-off label) (Rationale 35)
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date and time of starting infusion (Rationale 36)
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sign that you are responsible for its administration (Rationale 37)
Establish the frequency and type of observations that the child may require during the infusion according to their clinical condition (Rationale 38).
Check peripheral infusion access site half hourly for (Rationale 39):
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redness
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swelling/inflammation
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pallor
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leakage/oozing
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skin temperature change
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tenderness
If ANY appear STOP infusion.
Check all the infusion system is intact at least half hourly (Rationale 40, 41 and 42).
Record the following hourly (Rationale 43, 44, 45 and 46):
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infusion rate
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infusion pressures
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volume infused
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total volume infused
Observe child for minor reactions to blood product (Rationale 47), such as:
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sweating
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mottled appearance
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dizziness
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rash
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redness on chest
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flushing
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fever
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tachycardia
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nausea
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chills
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salivation
Observe child for major reactions to blood product eg (Rationale 47):
Volume overload can occur if the dosage and rate of infusion are too high (Rationale 47). Clinical signs and symptoms include:
Medical assistance should be sought if any of these symptoms occur.
Reaction management
If the reaction is unexpected:
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stop infusion (Rationale 48)
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infuse 0.9% sodium chloride for infusion using NEW Intravenous Solution Administration set (Rationale 49)
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obtain medical assistance (Rationale 50)
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record incident in child’s health care records (Rationale 51)
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complete an incident report on Datix©
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continue infusion when possible
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remember the infusion time
If child has a known potential for a reaction:
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stop infusion
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infuse 0.9% sodium chloride for infusion using NEW Intravenous Solution Administration set (Rationale 49)
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give prescribed steroid and anti-histamine (Rationale 48)
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continue infusion when child has recovered
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remember the infusion time
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inform doctor
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record in child’s health care records (Rationale 51)
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complete an incident report on Datix©
If a severe reaction occurs:
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stop infusion immediately (Rationale 52)
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infuse 0.9% sodium chloride for infusion using NEW Intravenous Solution Administration set (Rationale 49)
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seek urgent medical assistance
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give steroid and anti-histamine if prescribed (Rationale 48)
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record incident in child’s records (Rationale 51)
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complete an incident report on Datix©
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do not recommence infusion
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inform Pharmacy and ask for advice (Rationale 53)
Completing infusion
If the prescription is complete:
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Remove Pharmacy Red Tag and complete information and return to Pharmacy (Rationale 54).
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Electronic prescribing areas should chart that the infusion has been given and record the batch number (Rationale 54).
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Remove administration set using standard (universal) precautions and continue with planned treatment (Rationale 55).
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The needle/spike should be placed in the yellow sharps box. The bottle should be disposed of in accordance with the Waste Policy (Rationale 56).
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Do not put into sewage/water system (Rationale 57).
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If product is unused it must be returned to the Pharmacy and not used for any other patient (Rationale 58).
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If more than one bottle is required the same administration set can be used.
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If large volumes of albumin are required this should be planned with Pharmacy (Rationale 59).
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For ‘ward stocks’ – these will only be replaced when completed Red Tag is returned to Pharmacy (Rationale 58).
Rationale 1: 4.5% increases albumin level; expands plasma.
Rationale 2: 20% increases albumin level while minimising risk of fluid overload; useful when sodium levels are a problem.
Rationale 3: To restore volume.
Rationale 4: To replace protein.
Rationale 5: To rehydrate.
Rationale 6: To reduce oedema.
Rationale 7: To obtain "consent".
Rationale 8: To address any information requirements.
Rationale 9: To establish the normal parameters for a child.
Rationale 10: To rule out pre-existing disease processes if a reaction is suspected.
Rationale 11: Alterations in these could indicate a reaction.
Rationale 12: To enable infusion to commence.
Rationale 13: To maintain Hospital Policy.
Rationale 14: To prevent infusion errors.
Rationale 15: To maintain the effectiveness of the product, to meet the recommendations of the manufacturer and to reduce the risk of infection.
Rationale 16: To enable Pharmacy and clinical area to plan adequately.
Rationale 17: To ensure planning takes place.
Rationale 18: To ensure that central records are maintained and accurate.
Rationale 19: To prevent wastage of product through incorrect storage.
Rationale 20: To ensure the product is stored correctly.
Rationale 21: To ensure it is free from contamination.
Rationale 22: To prevent harm to the child.
Rationale 23: To ensure the correct dose is administered.
Rationale 24: To minimise the risk of infection.
Rationale 25: To prevent air embolism.
Rationale 26: To ensure administration set is patent.
Rationale 27: It is not compatible with any other intravenous product.
Rationale 28: To ensure the albumin solution is being connected to the right child.
Rationale 29: To maintain Hospital Policy.
Rationale 30: To minimise the risk of infection.
Rationale 31: To maintain the effectiveness of the product, to meet the manufacturer's recommendations.
Rationale 32: The administration set may retain up to 20ml of the blood product.
Rationale 33: To prevent fluid overload especially if fluids are being restricted.
Rationale 34: This is when reactions are most likely to occur.
Rationale 35: To assist product and child tracing.
Rationale 36: To ensure accuracy of records.
Rationale 37: To determine accountability for the infusion.
Rationale 38: To monitor for potential complications.
Rationale 39: To monitor for extravasation and phlebitis.
Rationale 40: To ensure the product is being infused.
Rationale 41: To prevent wastage.
Rationale 42: To prevent accidental spillage.
Rationale 43: To ensure rate remains correct.
Rationale 44: To detect for signs of extravasation.
Rationale 45: To prevent over-infusion.
Rationale 46: To ensure infusion pump is working correctly.
Rationale 47: To ensure safety of child.
Rationale 48: To stop reaction.
Rationale 49: To maintain patency of IV access device.
Rationale 50: To obtain prescription for steroid and antihistamine.
Rationale 51: To maintain accurate records.
Rationale 52: To minimise impact from reaction.
Rationale 53: To assist investigation of incident.
Rationale 54: To ensure correct infusion has been administered to correct patient and to complete documentation.
Rationale 55: To conclude treatment.
Rationale 56: To minimise risk of infection to handler.
Rationale 57: To reduce risk of infection by safe disposal.
Rationale 58: To ensure that central records are accurate.
Rationale 59: To ensure adequate stock is available.
Reference 1:
Bioproducts Laboratory (2001) Zenalb (R) Summary of product characteristics. Human Albumin Solution: 4.5%. Hertfordshire, Bioproducts Laboratory
Reference 2:
Bradbury M, Cruickshank JP (1995)Blood and blood transfusion reactions: 2. British Journal Nurs J Nurs 4 (15): 861-8.
Reference 3:
Grifols (2001) Human Albumin Solution 20%: Summary of Product Characteristics. Cambridge, Grifols
Reference 4:
McCelland M (2007) Handbook of Transfusion Medicine (4th edition). London, HMSO
Reference 5:
Nursing Education Working Group: National Blood Resource Education Program (1991) Preventing & managing transfusion reactions. American Journal of Nursing June: 48-50.
Reference 6:
Royal Pharmaceutical Society (1999) Martindale: The Extra Pharmacopoeia (32nd edition). London, Royal Pharmaceutical Society
Reference 7:
Royal Pharmaceutical Society (2000) British National Formulatory issue 41. London, Royal Pharmaceutical Society
Document control information
Lead author(s)
Judith Cope, Chief Pharmacist, Pharmacy
Document owner
Judith Cope, Chief Pharmacist, Pharmacy
Approved by
Clinical Practice Committee
First introduced: 30 June 2004
Date approved: 26 October 2011
Review schedule: Two years
Next review: 28 October 2013
Document version: 4.0
Replaces version: 3.0
