Standardized order set during LVP safely lowers amount of albumin dosing

Using an order set to guide albumin dosing based on the amount of ascitic fluid removed during large volume paracentesis (LVP) substantially reduces the quantity of albumin given with no difference in adverse effects, results of a study have shown.

The investigators examined the impact of implementing a standardized LVP order set on albumin utilization and patient outcomes in this retrospective review of patients with ascites due to cirrhosis who received a therapeutic paracentesis at a large, academic institution. 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).

The amount of albumin used prior to and after order set implementation was the primary outcome. Other patient outcomes included rates of hyponatraemia, renal impairment, and hypotension.

Each arm included 100 patients in the final analysis. Patients prior to order set implementation received a higher amount of albumin per litre removed than those postimplementation (8.3 vs 6.5 g/L; p<0.01).

No significant between-group differences were seen in absolute changes in serum sodium (0 vs −1 mEq/L; p=0.64), serum creatinine (0.06 vs 0.05 mg/dL; p=0.94), or systolic blood pressure (−4 vs −3 mm Hg; p=0.96). No differences were also noted in rates of hyponatraemia (1.6 percent vs 6.6 percent; p=0.21), renal impairment (11.3 percent vs 11.5 percent; p=0.97), or hypotension (17.4 percent vs 17.6 percent; p=0.97) between the two groups.

“Albumin after LVP reduces paracentesis-induced circulatory dysfunction. The most efficacious dose of albumin for LVP is unclear,” the investigators said.