Nursing care
Albumin infusion: oncotic action, circulatory overload and reaction checks
Written and reviewed by Michael Anderson, ADN, RN, CMSRN · 3 min read · Updated October 2026
Short answer
Albumin is a colloid made from human plasma that raises oncotic pressure and draws fluid into the bloodstream. It is used for hypovolaemia, after large-volume paracentesis in cirrhosis and in burns after initial crystalloid resuscitation. The main nursing risks are circulatory overload and pulmonary oedema, so slow or stop the infusion for overload signs and watch for allergic reactions.
How albumin works and when it is used
Albumin is the main protein that keeps fluid inside blood vessels through colloid osmotic, or oncotic, pressure. Infused albumin raises that pressure and pulls fluid from the tissues into the circulation. Concentrated albumin has a much stronger pulling effect than plasma, so patients receiving it need adequate hydration.
Labelled uses include restoring circulating volume in hypovolaemia, preventing central volume depletion after paracentesis for cirrhotic ascites, hypoalbuminaemia and burns. In burns, large volumes of crystalloid come first, and albumin may be used after the first day to maintain colloid osmotic pressure. On an exam, albumin is the fluid that expands volume by moving fluid, not by adding much of it.
Circulatory overload and other adverse effects
The most serious adverse reactions are anaphylactic shock, heart failure and pulmonary oedema. Hypervolaemia can develop if the rate is not matched to the patient's volume status, and the label lists early signs: headache, dyspnoea, jugular venous distension and rising blood pressure. At the first of these, slow or stop the infusion and report.
Albumin is contraindicated in severe anaemia or cardiac failure with normal or increased blood volume, and the label urges caution wherever extra volume or haemodilution is risky. The most common reactions are allergic-type, such as urticaria. Suspected anaphylaxis means stopping the infusion immediately and following the emergency protocol.
Monitoring before, during and after the infusion
Before starting, record baseline vital signs, lung sounds, oxygen saturation, weight or fluid balance and any history of heart or kidney disease. During the infusion, reassess blood pressure, heart rate, respiratory effort and lung sounds at the intervals your protocol sets, and keep the rate as ordered on a pump.
The label asks for monitoring of electrolytes, coagulation, blood counts and haemodynamic status, because albumin can dilute red cells and clotting factors. After paracentesis, watch for hypotension and falling urine output, which signal the central volume shift albumin is meant to prevent. Document the product, lot and the patient's response.
Handling the product safely
Albumin is a blood derivative, so follow local policy on consent and product checks. The label describes an extremely remote risk of viral or prion transmission because of donor screening and manufacturing processes. Inspect the solution before use and do not use it if it looks cloudy or has deposits.
Do not dilute albumin with sterile water for injection, because this can cause haemolysis in the recipient. Use the administration set and compatible fluids specified by the product information, and start the infusion promptly once the container is opened, following the manufacturer's time limit.
Worked example: breathless during an albumin infusion
Consider a hypothetical patient with cirrhosis and a history of heart failure who is receiving albumin after paracentesis and now reports a headache and shortness of breath, with new crackles and distended neck veins. Options include increasing the rate to finish before the next dose, slowing or stopping the infusion, sitting the patient up and notifying the prescriber, or giving a diuretic from a previous order.
Stopping or slowing the infusion, positioning upright and notifying the prescriber is correct, because these findings match the label's early signs of circulatory overload. Speeding up worsens overload, and using an old diuretic order bypasses the reassessment this change needs. Finishing the bag is not a goal when the patient shows these signs.
Sources and further reading
DailyMed: Albutein 5% (albumin human) prescribing information. Hypovolaemia and burn uses, overload signs and stopping the infusion, contraindications, monitoring of electrolytes, coagulation and haemodynamics, no sterile water dilution and transmission risk.
DailyMed: Albutein 25% (albumin human) prescribing information. Paracentesis indication, need for adequate hydration with concentrated albumin, anaphylactoid reactions and serious adverse reactions.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our med-surg practice questions are the closest set to what this page covers.
One question from the med-surg set
A client with chronic obstructive pulmonary disease has an oxygen saturation of 88% on 2 L/min via nasal cannula and is alert with no distress. What should the nurse do first?
Rationale
In COPD a saturation of 88–92% is the therapeutic target, not an emergency, and this client is alert with no distress. The first action is the independent nursing intervention that is least invasive and most likely to help: sit them up and reassess. Turning the oxygen up to 6 L/min risks blunting the hypoxic drive, and calling rapid response or drawing an ABG escalates ahead of an assessment you have not finished.
Answer: B
Common questions
Why is albumin given after a large paracentesis?
Removing a large volume of ascitic fluid can shift fluid out of the circulation. Albumin is labelled to prevent this central volume depletion in cirrhotic ascites.
What are early signs of fluid overload during an albumin infusion?
The label lists headache, dyspnoea, jugular venous distension and increased blood pressure. Slow or stop the infusion and notify the prescriber at the first sign.
Can albumin be diluted with sterile water?
No. Diluting albumin with sterile water for injection can cause haemolysis in the recipient. Use only the diluents specified in the product information.
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