Plasmanate

plasma protein fraction

(plaz-maproe -teen frak-shun) plasmaproteinfraction,

Plasmanate

(trade name),

Plasma-Plex

(trade name),

Plasmatein

(trade name),

Protenate

(trade name)

Classification

Therapeutic: volume expanders
Pharmacologic: blood products
Pregnancy Category: C

Indications

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 and Excretion: Unknown.Half-life: Unknown.

Time/action profile (intravascular volume expansion)

ROUTEONSETPEAKDURATION
IV15–30 minunknownunknown

Contraindications/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).

Adverse Reactions/Side Effects

Central nervous system

  • headache

Cardiovascular

  • hypotension
  • tachycardia
  • vascular overload

Gastrointestinal

  • excess salivation
  • nausea
  • vomiting

Dermatologic

  • erythema
  • urticaria

Musculoskeletal

  • back pain

Miscellaneous

  • infection
  • chills
  • fever
  • flushing

Interactions

Drug-Drug interaction

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 hrIntravenous (Adults) Hypovolemia—250–500 mL (12.5–25 g protein). Hypoproteinemia—1000–1500 mL (50–75 g protein).Intravenous (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

Nursing implications

Nursing 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.

Potential Nursing Diagnoses

Decreased cardiac output (Indications)
Deficient fluid volume (Indications)
Excess fluid volume (Side Effects)

Implementation

  • Intravenous 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

Patient/Family Teaching

  • Explain the rationale for use of this solution to the patient.

Evaluation/Desired Outcomes

  • Increase in BP and blood volume.
  • Elevated serum plasma protein in patients with hypoproteinemia.

Plasmanate®

A proprietary plasma protein fraction that is 90% albumin by volume and used as a volume expander. See Albumin, Colloid solutions. Cf Crystalloid solutions.