What is the recommended rate for administering albumin infusion during paracentesis (peritoneal fluid removal)?

From the Guidelines

For large-volume paracentesis (removal of more than 5 liters of ascitic fluid), albumin should be administered at a dose of 8 grams per liter of ascitic fluid removed, as recommended by the most recent and highest quality study 1. The infusion should begin during the paracentesis or immediately after completion.

• A typical infusion rate is 100-200 mL per hour, which allows for the albumin to be given over 2-4 hours.
• For example, if 8 liters of ascitic fluid are removed, 64 grams of albumin should be given.
• Using a 25% albumin solution (25 grams per 100 mL), this would equate to 256 mL of albumin solution.
• This volume can be safely infused over 2-3 hours. The albumin infusion helps to maintain intravascular volume and reduce the risk of post-paracentesis circulatory dysfunction, as supported by previous studies 1. It's essential to monitor the patient's vital signs and symptoms during the infusion.
• If signs of volume overload occur (such as shortness of breath or increasing blood pressure), the infusion rate should be slowed or temporarily stopped. In patients with renal or cardiac dysfunction, a slower infusion rate may be necessary to prevent fluid overload.
• Always assess the patient's overall clinical condition when determining the infusion rate. The use of albumin as a plasma expander has been shown to be effective in preventing paracentesis-induced circulatory dysfunction and reducing the risk of complications, as demonstrated in a meta-analysis of 17 randomized studies 1.

From the FDA Drug Label

Removal of ascitic fluid from a patient with cirrhosis may cause changes in cardiovascular function and even result in hypovolemic shock. In such circumstances, the use of an albumin infusion may be required to support the blood volume. Since hypoproteinemic patients usually have approximately normal blood volumes, the rate of administration of Plasbumin-25 should not exceed 2 mL per minute, as more rapid injection may precipitate circulatory embarrassment and pulmonary edema.

The recommended rate for administering albumin infusion during paracentesis is not to exceed 2 mL per minute 2.

From the Research

Albumin Infusion Rate for Paracentesis

The recommended rate for administering albumin infusion during paracentesis is not explicitly stated in terms of a specific rate, but rather as a dose based on the volume of ascitic fluid removed.

• The dose of albumin is typically standardized to 6-8 g/l of ascitic fluid removed 3
• A study suggests standardizing albumin doses to 25 g (5-6 L removed), 50 g (7-10 L), and 75 g (>10 L) 4
• Another study found that albumin infusion reduces the incidence of postparacentesis circulatory dysfunction among patients with cirrhosis and tense ascites, as compared with no treatment 5
• The use of an order set to guide albumin dosing based on the amount of ascitic fluid removed during large-volume paracentesis resulted in a significant reduction in the amount of albumin given with no difference in adverse effects 4

Key Findings

• Albumin infusion is recommended for patients undergoing large-volume paracentesis to prevent postparacentesis circulatory dysfunction 5, 3, 6
• The dose of albumin should be based on the volume of ascitic fluid removed, with a typical dose of 6-8 g/l 3
• Standardizing albumin doses can help reduce the amount of albumin used without increasing adverse effects 4