What is the recommended dose of albumin (human albumin) for a patient undergoing a ponction (percutaneous procedure)?

Albumin Dosing for Paracentesis

For patients undergoing large-volume paracentesis (>5L), albumin should be administered at a dose of 8g per liter of ascites removed, using 20% or 25% albumin solution, infused after the paracentesis is completed. 1, 2

Dosing Guidelines by Procedure Type

Large-Volume Paracentesis (>5L)

• Administer 8g albumin per liter of ascites removed 1
• Use 20% or 25% albumin solution 1, 2
• Infuse after paracentesis completion, not during the procedure 2
• Complete paracentesis in a single session, draining ascites as rapidly as possible over 1-4 hours 2

Small-Volume Paracentesis (<5L)

• Albumin replacement generally not required for volumes less than 5L 1, 2
• Consider albumin replacement at 8g/L even for volumes <5L in high-risk patients (those with acute-on-chronic liver failure or high risk of post-paracentesis acute kidney injury) 2

Clinical Rationale for Albumin Use in Paracentesis

• Prevents post-paracentesis circulatory dysfunction (PICD), which can lead to renal impairment and hepatorenal syndrome 2
• Decreases incidence of hyponatremia compared to alternative plasma expanders (OR=0.61,95% CI 0.40 to 0.93) 1
• Superior to other volume expanders for prevention of paracentesis-induced circulatory dysfunction 1
• Reduces risk of renal dysfunction after large-volume paracentesis 1

Special Considerations

Patients with Spontaneous Bacterial Peritonitis (SBP)

• Different dosing regimen required: 1.5g albumin/kg within 6 hours of diagnosis, followed by 1g/kg on day 3 1, 3
• This dosing reduces risk of renal dysfunction by 72% and mortality by 47% in SBP patients 1, 3
• If large-volume paracentesis is indicated in a patient with SBP, proceed with albumin support using the paracentesis dosing protocol 1

Cost Considerations

• Albumin is more expensive than crystalloids and other alternatives 3, 4
• Two small RCTs compared standard dose (6-8g/L) with low-dose albumin (2-4g/L) and found no difference in post-paracentesis circulatory dysfunction, but sample sizes were small 1
• Despite cost concerns, albumin remains the preferred plasma expander for paracentesis due to superior outcomes 1

Potential Adverse Effects

• Fluid overload, particularly in patients with cardiac issues 3, 5
• Hypotension and hemodilution requiring RBC transfusion 3
• Anaphylaxis (rare) 3

Practical Administration Tips

• Insert needle into the left (preferably) or right lower abdominal quadrant using the "Z" track technique 2
• Use a cannula with multiple side perforations to prevent blockage by bowel wall 2
• Do not leave drain in overnight 2
• Consider ultrasound guidance when available to reduce risk of adverse events 2