PAEDIATRIC 20% HUMAN ALBUMIN (ZENALB®) INFUSION CARE-PLAN FOR THE TREATMENT OF CLINICAL
HYPOVOLAEMIA OR SYMPTOMATIC OEDEMA IN CHILDHOOD NEPHROTIC SYNDROME.
Surname
PROBLEM
1/ Needs an
invasive
procedure
REASON
Forename
INTERVENTIONS
Intravenous access is required
for 20% human albumin as it is
given slowly over 4-6 hours.
20% Albumin may exacerbate
any existing breathing problems.





2/ Needs a blood
product
transfusion
20% Human Albumin is a
hyperoncotic solution containing
95% albumin derived from
human blood, which is four times
the strength of plasma. It is
used for the treatment of clinical
hypovolaemia or symptomatic
oedema. A low serum albumin
alone is not an indication of
intravenous albumin.








CHI
SIGNATURE/
DATE
Ensure child/parents fully aware of procedure.
Ensure local anaesthetic is offered for cannula insertion.
Ensure play specialist involved where necessary.
Ensure adequate venous access gained (preferably 22GA
cannula as albumin is a large molecule).
Ensure patient is clerked in by a doctor and ensure full clinical
assessment is carried out and patient confirmed fit for
infusion.
Ensure 20% Human albumin solution ordered from pharmacy
(available in 50ml and 100ml bottles).
Ensure infusion prescribed correctly (5mls/kg of 20% Human
Albumin given over 4-6 hours intravenously).
Sign, date and time infusion started along with manufacturer
sticker from each bottle as it is used onto prescription chart.
Although blood derived product the patient’s blood group is
not taken into account with albumin infusions.
Ensure no previous administration issues, known allergies or
infusion reactions to albumin prior to administration.
Cardiac failure and severe anaemia are contra-indications.
Record pre infusion temperature, pulse, respiration rate and
blood pressure, then half hourly during infusion. Record 02
saturation levels continuously and for two hours post infusion.
Administer as per prescription following non-touch technique
using normal infusion line and as per hospital infusion policy.
1
3/ Is at risk of
cardiovascular
overload
Circulating blood volume is
increased by restoring the serum
albumin levels which pulls fluid
into the veins from the tissues.
Volume overload can also occur
if dosage and rate of infusion too
high.
4/ Is at risk of
pulmonary
oedema
If grossly oedematous, fluid can
sometimes shift into the
pulmonary spaces, with the
administration of albumin
causing breathing difficulties.

20% albumin is compatible with 0.9% sodium chloride and
5% glucose. It should be stored in cool dry place away from
sunlight (store in original packaging). It should be given at
room temperature and used within 3 hours of opening.

Signs of hypervolaemia are: headache, hypertension,
increased jugular venous pressure.
Ensure furosemide (2mg/kg intravenously) is prescribed with
every 20% albumin infusion, either midway/end (bolus over 510 minutes) or alongside infusion (dilute with sodium chloride
0.9% to a concentration of 1-2mg/ml given over 4-6 hours) to
prevent cardiovascular overload.
Ensure child has passed urine prior to discharge home.
Ensure child is closely monitored throughout the infusion and
where possible the infusion is administered whilst the child is
awake and sitting upright and during working day hours.
Ensure oxygen and suction in working order at child’s
bedside.
Stop infusion and notify medical staff if child desaturates,
develops shortness of breath, difficulty breathing, wheezing,
chest pain, tachycardia, tachypnea.
Stop infusion and notify medical staff if child develops
flushing, fever, rash, pruritis, headache, dizziness,
tachycardia, nausea, chills, salivation, rigor.
If anaphylaxis occurs follow anaphylaxis algorithm.





5/ Is at risk of
infusion reaction.
20% Human Albumin is derived
from human blood plasma
donations. Donors are screened
and methods to kill or remove
viruses are used.


References:
British national formulary for children.
Royal Hospital for Sick Children (RHSC), Yorkhill Nephrotic Syndrome Guideline
C:\Documents and Settings\lwatson\Local Settings\Temporary Internet Files\Copy of 20% Albumin careplan v2 DAH.doc adapted from Aberdeen careplan doc - Lisa Vallance 05/02/2016
2