Albumin in TPN solutions: potential savings from a prospective review.

As a result of the common usage of albumin in total parenteral nutrition (TPN) solutions at The Ohio State University Hospitals, a review of the use of this product was performed. Albumin therapy in 18 patients was evaluated using prospective criteria. Therapy was considered appropriate if the serum albumin level was less than or equal to 3.0 g%. Using these criteria, 12 of 18 patients (67%) received albumin in the TPN solution. Of these 12 patients, 7 received albumin unnecessarily. During the 3-week review, a total of 168 vials of 50 ml, 25% albumin (2100 g) were administered to patients with serum albumin concentrations greater than 3.0/100 ml at a cost of $6,014. Over a year, this could mean over $100,00 in costs which could be eliminated. Criteria for use of albumin in malnourished patients receiving TPN are not well established. This study demonstrated that developing simple criteria for the prospective review of albumin in TPN solutions and using them to monitor albumin therapy closely, can result in very significant cost savings to patients receiving TPN.