plasma protein fraction

REMS

Expansion of plasma volume and maintenance of cardiac output in situations associated with deficiencies in circulatory volume, including:
- Shock,
- Hemorrhage,
- Burns.
Temporary replacement therapy in edema associated with low plasma proteins, such as the nephrotic syndrome and end-stage liver disease.

Action ⬆ ⬇

Provides colloidal osmotic pressure (in the form of albumin and globulins) within the intravascular space, causing the shift of water from extravascular tissues back into the intravascular space.

Therapeutic effects:

Mobilization of fluid from extravascular tissue into intravascular space.

Pharmacokinetics ⬆ ⬇

Absorption: Administered IV only, resulting in complete bioavailability.

Distribution: Stays mainly in the intravascular space.

Metabolism/Excretion: Unknown.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(intravascular volume expansion)

ROUTE	ONSET	PEAK	DURATION
IV	15–30 min	unknown	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Allergic reactions to albumin;
Severe anemia;
HF;
Normal or increased intravascular volume;
Cardiopulmonary bypass procedures.

Use Cautiously in:

Severe hepatic or renal disease;
Rapid infusion (may cause hypotension or hypertension);
Dehydration (additional fluids may be required);
Large doses (may cause anemia, requiring transfusion).

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypotension, tachycardia, vascular overload

Derm: erythema, urticaria

GI: excess salivation, nausea, vomiting

MS: back pain

Neuro: headache

Misc: chills, fever, flushing, infection

Interactions ⬆ ⬇

Drug-drug:

None significant.

Route/Dosage ⬆ ⬇

Dose is highly individualized and depends on condition being treated. Contains 130–160 mEq sodium/liter. Not to exceed 250 g/24 hr
IV (Adults ): Hypovolemia: 250–500 mL (12.5–25 g protein). Hypoproteinemia: 1000–1500 mL (50–75 g protein).
IV (Infants and Young Children): Hypovolemia: 10–30 mL/kg (0.5–1.5 g protein/kg).

Availability ⬆ ⬇

Injection: 5% in 50-; 250-; and 500-mL containers

Assessment ⬆ ⬇

Monitor vital signs, CVP, pulmonary capillary wedge pressure (PCWP), and intake and output before and frequently throughout therapy. Hypotension may result from too rapid infusion. If hypotension occurs, decrease rate or discontinue infusion.
Assess for signs of vascular overload (↑ CVP, ↑ PCWP, rales/crackles, dyspnea, hypertension, jugular venous distention) during and after administration.
Assess surgical patients for increased bleeding after administration caused by increased BP and circulating blood volume. Plasma protein fraction does not contain clotting factors.

Lab Test Considerations:

Monitor hemoglobin, hematocrit, serum protein, and electrolytes throughout therapy.

Implementation ⬆ ⬇

IV Administration:

Administer through a large-gauge (at least 20-gauge) needle. Use administration set provided by manufacturer.
- Solution may vary from nearly colorless to straw to brownish. Do not use cloudy solution. Store at room temperature. Do not administer more than 250 g (5000 mL 5%) in 24 hr.
- There is no danger of serum hepatitis from plasma protein fraction. Crossmatching is not required.
- Dehydration should be corrected by additional IV fluids.
Intermittent Infusion: Administer plasma protein fraction undiluted by IV infusion. Infusion must be completed within 4 hr.
Rate: Rate of administration is determined by blood volume, indication, and patient response but should not exceed 10 mL/min, to minimize the possibility of hypotension. As the plasma volume approaches normal, the rate of administration should not exceed 5–8 mL/min. The rate for infants and children should not exceed 5–10 mL/min. Monitor the patient for signs of hypervolemia.
Additive Compatibility:
- calcium gluconate
- chloramphenicol
- packed red blood cells
- whole blood
Additive Incompatibility:
- alcohol
- amino acids
- norepinephrine
- solutions containing protein hydrolysates

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇