Standardizing the Use of Albumin in Large Volume Paracentesis

Shelby S. Anderson, Julian B. McCreary, Kristin S. Alvarez, L. Steven Brown, Deepak Agrawal

Research output: Contribution to journalArticle

Abstract

Background: Albumin after large volume paracentesis (LVP) reduces paracentesis-induced circulatory dysfunction (PICD). The most efficacious dose of albumin for LVP is unclear. Objective: To evaluate the impact of implementing a standardized LVP order set on albumin utilization and patient outcomes. Methods: This is a retrospective review of patients with ascites due to cirrhosis who received a therapeutic paracentesis at a large, academic institution. Primary outcome was amount of albumin used prior to and after order set implementation. Albumin doses were standardized in the order set to 25 g (5-6 L removed), 50 g (7-10 L), and 75 g (>10 L). Patient outcomes were rates of hyponatremia, renal impairment, and hypotension. Results: There were 100 patients included in each arm of the final analysis. Patients prior to order set implementation received a higher amount of albumin per liter removed compared to those post-implementation (8.3 g/L vs 6.5 g/L, respectively; P <.01). There were no significant differences between groups in absolute changes in serum sodium (0 mEq/L vs −1 mEq/L, P =.64), serum creatinine (0.06 mg/dL vs 0.05 mg/dL, P =.94), or systolic blood pressure (−4 mm Hg vs −3 mm Hg, P =.96). There were no differences between groups in rates of hyponatremia (1.6% vs 6.6%, P =.21), renal impairment (11.3% vs 11.5%, P =.97), or hypotension (17.4% vs 17.6%, P =.97). Conclusions: Use of an order set to guide albumin dosing based on amount of ascitic fluid removed during LVP resulted in a significant reduction in the amount of albumin given with no difference in adverse effects.

Original languageEnglish (US)
JournalJournal of Pharmacy Practice
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Paracentesis
Albumins
Hyponatremia
Hypotension
Blood Pressure
Kidney
Ascitic Fluid
Serum
Ascites
Creatinine
Fibrosis
Sodium

Keywords

  • albumin
  • cirrhosis
  • internal medicine
  • order set
  • PICD

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

Anderson, S. S., McCreary, J. B., Alvarez, K. S., Brown, L. S., & Agrawal, D. (Accepted/In press). Standardizing the Use of Albumin in Large Volume Paracentesis. Journal of Pharmacy Practice. https://doi.org/10.1177/0897190018816252

Standardizing the Use of Albumin in Large Volume Paracentesis. / Anderson, Shelby S.; McCreary, Julian B.; Alvarez, Kristin S.; Brown, L. Steven; Agrawal, Deepak.

In: Journal of Pharmacy Practice, 01.01.2018.

Research output: Contribution to journalArticle

Anderson, Shelby S. ; McCreary, Julian B. ; Alvarez, Kristin S. ; Brown, L. Steven ; Agrawal, Deepak. / Standardizing the Use of Albumin in Large Volume Paracentesis. In: Journal of Pharmacy Practice. 2018.
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abstract = "Background: Albumin after large volume paracentesis (LVP) reduces paracentesis-induced circulatory dysfunction (PICD). The most efficacious dose of albumin for LVP is unclear. Objective: To evaluate the impact of implementing a standardized LVP order set on albumin utilization and patient outcomes. Methods: This is a retrospective review of patients with ascites due to cirrhosis who received a therapeutic paracentesis at a large, academic institution. Primary outcome was amount of albumin used prior to and after order set implementation. Albumin doses were standardized in the order set to 25 g (5-6 L removed), 50 g (7-10 L), and 75 g (>10 L). Patient outcomes were rates of hyponatremia, renal impairment, and hypotension. Results: There were 100 patients included in each arm of the final analysis. Patients prior to order set implementation received a higher amount of albumin per liter removed compared to those post-implementation (8.3 g/L vs 6.5 g/L, respectively; P <.01). There were no significant differences between groups in absolute changes in serum sodium (0 mEq/L vs −1 mEq/L, P =.64), serum creatinine (0.06 mg/dL vs 0.05 mg/dL, P =.94), or systolic blood pressure (−4 mm Hg vs −3 mm Hg, P =.96). There were no differences between groups in rates of hyponatremia (1.6{\%} vs 6.6{\%}, P =.21), renal impairment (11.3{\%} vs 11.5{\%}, P =.97), or hypotension (17.4{\%} vs 17.6{\%}, P =.97). Conclusions: Use of an order set to guide albumin dosing based on amount of ascitic fluid removed during LVP resulted in a significant reduction in the amount of albumin given with no difference in adverse effects.",
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