[alarla]

What is everyone doing about drawing peaks and troughs? At my LTC facility, we have a patient with a PICC. The lab does not draw from PICC lines so the RN has to do it. The patient gets Vancomycin at 8 am. Should the trough be done right at 8:00 or at 7:00 am? Same with the peak - the vanco infuses for an hour so should the peak be drawn at 9:00 or 10:00? And no, we do not have a pplicy for this. The DON, ADON, and manager were arguing but were unable to decide. I figured I'd ask here. Thanks for any advice!

[mommatrauma]

When I worked on the floor we did the trough just before the med was hung, and we did the peak 60 min after the med was finished infusing

[HillaryC]

Originally Posted by alterson

What is everyone doing about drawing peaks and troughs? At my LTC facility, we have a patient with a PICC. The lab does not draw from PICC lines so the RN has to do it. The patient gets Vancomycin at 8 am. Should the trough be done right at 8:00 or at 7:00 am? Same with the peak - the vanco infuses for an hour so should the peak be drawn at 9:00 or 10:00? And no, we do not have a pplicy for this. The DON, ADON, and manager were arguing but were unable to decide. I figured I'd ask here. Thanks for any advice!

At my facility, we do troughs 30 minutes before giving the dose, and peaks 30 minutes after the dose ends.

[mommatrauma]

Here's a link from a lab about it...

http://www.utmb.edu/lsg/LabSurvivalG...ANCOMYCIN.html

that's just one lab though...I went to many different sites, and the trough levels varied from 30 min prior to just before infusion starts...and the peak being drawn at anywhere from 30 min-120 min after infusion was finished, noting that more than one of the places I looked stated that the 30 min peak can be very variable as much as 10-15 mcg/ml for every 15 minutes...A few of the other sites I visited also stated that peaks aren't really effective for monitoring and dosing effectiveness of drug and are rarely used anymore...I don't work in an area that we need to do this type of testing anymore, so I'm not sure how valid that is.

[shopgal]

Yeah, our protocol is no more than 30 min before infusion and then a 30 min to 1 hour window after infusion. We always draw them 72 hours after the initial dose.

[NRSKarenRN]

If you have no policy, ASK THE DOCTOR WHAT HE WANTS!

In home care infustion, I usually drew trough 1 hour prior to start infusion, peak 1 hour after infusion finished. However, some docs wanted rough drawn immediatly prior to infusion... rarely.peak as much as 90 hours post infusion if poor renal clearance. 72 hours after initial vanco treatment infrequently requested too.

Most important thing is to make a decision and stick with the times ---write on lab slip too how done so can be added to computer printout.

[PeachyOrthoRN]

Our hospital's policy is 5-30 minutes before infusion for the trough and one hour after it's been infused for the peak. Hope this helps.

[Tweety]

Our policy is within one hour prior. Give or take a few is o.k. The last several years we've stopped doing peaks and usually only do troughs. Occasionally the pharmacy will order a peak 12 hours after the first dose in hung. I'm sure this is evidenced based but don't have the resource.

[Kudra]

for those of you who draw blood work just before giving the dose: how long does it take your lab to run the vanco level? do you hang the med before you know your lab results?

i use to go ahead and hang the med before i got the level back (usually the lab wouldn't come to draw the lab work until 5 minutes before the dose was scheduled... then, of course, it would take a minimum of 30 minutes to get the lab work back which screws up your med schedule)... but the last time i did this, the patient ended up having a toxic level of vanco in his system... i stopped the infusion (he had gotten approx. 50 ml of a 250 ml bag), flushed the line and informed the charge nurse... the patient was fine, but obviously, i'm at fault because i hung the med without the trough level... i'll never hang vanco again without having my blood work back first...

[PeachyOrthoRN]

In our hospital we go ahead and hang the dose. On may occasions the trough has come back critically high,and we have called the infectious disease doc's they just tell us that a trough is useless without a peak critically high or not, besides 9/10 times the peak comes back normal or even low and the doc's have to adjust the vanco dose anyway. Go figure!