PLASMA PROTEIN FRACTION

PLASMA PROTEIN FRACTION (plas'ma) Plasmanate, Plasma-Plex, Protenate Classifications: plasma volume expander; Therapeutic: plasma volume expander; albumin Prototype: Normal serum albumin, human Pregnancy Category: C

Availability

5% injection

Action

Provides plasma proteins that increase colloidal osmotic pressure within the intravascular compartment equal to human plasma; it shifts water from the extravascular tissues back into the intravascular space, thus expanding plasma volume. No coagulation factors or gamma globulins are provided.

Therapeutic Effect

It is used to maintain cardiac output by expanding plasma volume in the treatment of shock due to various causes. Does not require cross matching.

Uses

Emergency treatment of hypovolemic shock due to burns, trauma, surgery, infections; temporary measure in treatment of blood loss when whole blood is not available; to replenish plasma protein in patients with hypoproteinemia (if sodium restriction is not a problem).

Contraindications

Hypersensitivity to albumin; severe anemia; cardiac failure; patients undergoing cardiopulmonary bypass surgery; pregnancy (category C).

Cautious Use

Patients with low cardiac reserve; absence of albumin deficiency; liver or kidney failure.

Route & Dosage

Plasma Volume Expansion Adult: IV 250–500 mL at a maximum rate of 10 mL/min Child: IV 6.6–30 mL/kg at a rate of 5–10 mL/min Hypoproteinemia Adult: IV 1–1.5 L/d infused at a rate not to exceed 5–8 mL/min

Administration

Intravenous Do not use solutions that show a sediment or appear turbid. Do not use solutions that have been frozen. PREPARE: IV Infusion: Give undiluted. Once container is opened, solution should be used within 4 h because it contains no preservatives. Discard unused portions.   ADMINISTER: IV Infusion: Rate of infusion and volume of total dose will depend on patient's age, diagnosis, degree of venous and pulmonary congestion, Hct, and Hgb determinations. As with any oncotically active solution, infusion rate should be relatively slow. Range may vary from 1–10 mL/min.   INCOMPATIBILITIES Protein hydrolysates or solutions containing alcohol.

Adverse Effects (≥1%)

GI: Nausea, vomiting, hypersalivation, headache. Body as a Whole: Tingling, chills, fever, cyanosis, chest tightness, backache, urticaria, erythema, shock (systemic anaphylaxis), circulatory overload, pulmonary edema.

Nursing Implications

Assessment & Drug Effects

• Monitor vital signs (BP and pulse). Frequency depends on patient's condition. Flow rate adjustments are made according to clinical response and BP. Slow or stop infusion if patient suddenly becomes hypotensive.
• Report a widening pulse pressure (difference between systolic and diastolic); it correlates with increase in cardiac output.
• Report changes in I&O ratio and pattern.
• Observe patient closely during and after infusion for signs of hypervolemia or circulatory overload (see Appendix F). Report these symptoms immediately to physician.
• Make careful observations of patient who has had either injury or surgery in order to detect bleeding points that failed to bleed at lower BP.

---

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug