Albumin administration rate and IV tubing

[arms]

How fast do we infuse albumin? Is it 30 minutes or 1 hour or 2 hours? Special long tubing-a primary tubing comes from pharmacy. I thought it would be secondary tubing. It has that rolling drip regulator, and I can't even put in the IV pump but only to flow by gravity. It's kind of tiring because I have to manually regulate and count the rate. Do you infuse it by gravity too? Can I directly connect the tube to the IV heplock or I can Y tube it nearest to the patient but still by gravity? Or can I connect it as secondary using the special long tubing provided by pharmacy but only thing is it will be long enough to use as secondary. Now, I have to raise the IV pole as high as possible. Am I doing the right thing? There are occasions that the drip stops, so I have to squeeze the drip chamber and open and close the vent. The albumin comes in glass bottle. Please help.

[iluvivt, BSN, RN]

Albumin should be started at a slow rate of 2-3 ml per min and can be increased to patient tolerance. Albumin comes in 2 concentrations a 5% in 250 ml and a 25% in 50 ml. The 5% is isotonic and the 25% is hypertonic. 50 ml of the 25% is osmotically equivalent to 250 ml citrated plasma.Albumin must be administered with caution as a too rapid infusion can lead to circulatory overload or interstitial dehydration in some vulnerable patients. Remember that Albumin is a large molecule and will pull fluid into the vascualr space

The product has no preservatives so once spiked yo should use it or discard. It is heat treated to inactivate the hepatitis virus. Do not leave it spiked and hanging for future use. The Albumin should not be added to any IV solution. You should use the administration set that comes with the product...there may be a small membrane filter in the drip chamber. Some have a plastic bag with it and you slip the glass bottle into that to hang it. the best way to hang it is to administer directly at the IV site or if you have a dedicated lumen on a PIV or CVC that is even better. Try to get the bottle at least 3 feet above the level of the patients heart. Albumin is thick so use a large gauge catheter or select the largest lumen of any CVC you may have. It will get real bubbly at the end of the infusion....this is normal. Reactions are rare and usually related to improper administration....bacterial contamination is also rare,but can happen. Hope this helps.

[bethem]

In ICU we slam it in stat.

[schroeders_piano, RN]

The ICU I work we do Albumin drips all the time. 50grams over 24 hours. We run it on the pump and it comes to like 8.3ml/hr

[iluvivt, BSN, RN]

you can slam it in if you need to...just monitor for fluid shifts...... if need not urgent better to start as recommended. A rate of greater than 10 ml per min can cause circulatory overload and pulmonary edema.

[Trulytam]

Interestingly enough we are having the same sort of debate at my hospital. I work for the float pool so i travel to the majority of the departments. I noticed that the med surg department used the tubing that came up from pharmacy but it didnt work on the pump they then eye the drips and monitor that with nine other critical patients. Yet a more critical unit in the same facility uses their own fashioned tubing and pharmacy doesnt even send anything to that floor. With their created tubing it infuses on the pump without complications. Their method: take a primary line add a spike adaptor and a filter to the end of the tubing.

[Miss Kitty00]

We have this argument on our unit too. I work on a med-surg unit that will give Albumin 25mg to dialysis patients when their blood pressure is low. I was always told to hang to gravity (it usually drips within 30 minutes)with the tubing that pharmacy sends up. Other nurses argue that it needs to be put on a pump because thats what blood bank recommends. I don't know what to do, because technically both ways are right. But is it wrong to hang it to gravity with a dialysis patient?

[Kittyfeet]

When I hung albumin with my preceptor it came in the glass bottle and we hung it with the tubing the pharmacy sent and hung it to gravity directly to the patient's saline lock. I just watched the drips and made sure it wasn't going too fast and it went in a little over 30 minutes.

[RockyCreek]

The volume, choice of options and rate of infusion are varied according to the reason for the administration and the response of the individual patient. For example, a patient with hypovolemic shock in an ICU setting could get a lot of albumin in a short period of time but a burn patient should get less over a longer period to prevent fluid shifting. I have always used the filtered IV line and infused with gravity -- both when I worked in CVICU and now on a General Surgical floor. It is compatile with all the standard IV fluids but not TPN, PPN, lipids, etc. so I piggyback it into the existing IV whenever possible. [i never run anything into any blood products although I have seen it done -- just my personal standard.] Also, since it is made from human blood plasma, you have to be alert for allergic reactions -- I have never seen it happen but a couple of other nurses have told me that they did.

[carolina4]

in our icu (surgical trauma burn) we run it in wide open using normal primary tubing, using gravity (aka climb on a chair and hang it waaay up high)...always flush after/between albumin infusions b/c albumin is super sticky.

p.s. burn pts most definitely receive albumin wide open to gravity as well...unless it's the initial day of the burn or the one after

[Neferet]

I remember hanging this. Was my first time, and it was a pain in the butt. Tubing comes from the pharmacy. Special tubing for albumin...it's not the primary or secondary...but a different one. The reason is that the albumin is so thick...that the special tubing has a little opening valve to open and let air through so that the line can be primed and the fluids will flow. Then hook it up to the pump. Doesn't work well with regular IV tubing at all, because you can see it's a hard container with no positive pressure. With this special one, it flows really nice, and primed in less than a minute.

[Sunnysidegirl]

In my facility we hang albumin with the tubing from pharmacy and hang it to gravity directly to the patients line. When I was working with my preceptor she hung it with regular secondary tubing and it wouldn't infuse it is just too darn thick. We had to put it on a pump (set to a very slow rate).Later when I was on my own I found it came with its own tubing. the nurses on my unit told me to hang it to gravity.It does not infuse too quickly given its viscosity.The drug book says for albumin 25% for normal blood vol is 1 to 2 ml/min. If the pt in hypovolemic then run 25% as rapidly as tolerated then when bl vol reaches normal then titrate to 1ml/min.So the rate should really depend on the pts blood vol status and protien needs.