TY - JOUR
T1 - Standardizing the Use of Albumin in Large Volume Paracentesis
AU - Anderson, Shelby S.
AU - McCreary, Julian B.
AU - Alvarez, Kristin S.
AU - Brown, L. Steven
AU - Agrawal, Deepak
PY - 2020/8/1
Y1 - 2020/8/1
N2 - 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.
AB - 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.
KW - PICD
KW - albumin
KW - cirrhosis
KW - internal medicine
KW - order set
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U2 - 10.1177/0897190018816252
DO - 10.1177/0897190018816252
M3 - Article
C2 - 30522384
AN - SCOPUS:85059349462
VL - 33
SP - 420
EP - 424
JO - Journal of Pharmacy Practice
JF - Journal of Pharmacy Practice
SN - 0897-1900
IS - 4
ER -