Albumin Infusion Protocol for Large Volume Paracentesis
Dosing Guidelines
- For paracentesis >5 liters, the American Gastroenterological Association recommends administering 8 g albumin per liter of ascites removed (e.g., 100 ml of 20% albumin per 3 liters of ascites) 1, 3
- For high-risk patients (those with acute-on-chronic liver failure or high risk of post-paracentesis acute kidney injury), consider albumin replacement at 8 g/L even for volumes <5 liters 1
Administration Protocol
- Infuse albumin after paracentesis is completed, not during the procedure, using 20% or 25% albumin solution 1, 3
- Complete the paracentesis in a single session, draining ascites to dryness as rapidly as possible over 1-4 hours 3, 4
Clinical Rationale
- Albumin replacement prevents post-paracentesis circulatory dysfunction (PICD), which can lead to serious complications including renal impairment and hepatorenal syndrome 1, 3
- Studies show significantly higher rates of renal impairment, hyponatremia, and activation of the renin-angiotensin-aldosterone system in patients not treated with albumin after large volume paracentesis 3, 5
Special Considerations
- For patients with spontaneous bacterial peritonitis (SBP), use a different dosing regimen: 1.5 g albumin/kg within 6 hours of diagnosis, followed by 1 g/kg on day 3 1
Procedure Technique
- Insert the needle into the left (preferably) or right lower abdominal quadrant using the "Z" track technique 3, 4
- Use a cannula with multiple side perforations to prevent blockage by bowel wall 3, 4