Standardizing the Use of Albumin in Large Volume Paracentesis.

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; < .01). There were no significant differences between groups in absolute changes in serum sodium (0 mEq/L vs -1 mEq/L, = .64), serum creatinine (0.06 mg/dL vs 0.05 mg/dL, = .94), or systolic blood pressure (-4 mm Hg vs -3 mm Hg, = .96). There were no differences between groups in rates of hyponatremia (1.6% vs 6.6%, = .21), renal impairment (11.3% vs 11.5%, = .97), or hypotension (17.4% vs 17.6%, = .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.