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A question came up yesterday. At my facilty you get the trough right before the vanco dose, then start up the vanco dose. The peak was due to be drawn 1/2 hour after the dose was in. The doc had ordered it done on the 2200 dose. One nurse challanged me because I didn't hold the vanco until after the trough came back. He's worked elsewhere, I work with him in ICU, but this was a Med-Surg pt that I was handing over after 4 hours, after having floated.
Anyways he said that he always waits to start the vanco until after the trough is back, that it was protocol where he worked before. I discussed it with other co-workers and traditionally where I work we start up the vanco immediately, leaving the trough and peak for pharmacy and the doc to evaluate. I discussed it in the morning with yet another co-worker and we all agreed that perhaps we need clarification on this.
What is the policy where you work? Any opinions? We are going to bring up this question with pharmacy and our manager.
hi garden dove. where i used to work we drew the trough (with a BUN/cr too) an hour before dose was due, then hung the drug. we didn't wait till the results came back. (of course that was in a rehab unit offsite from the hospital, likeLTC).
our labs were faxed to us on the floor and directly to the pharmacy too, so they could order a different dose or maintain them.
HTH.
and this was the orders from our docs as well. that was our policy.
We do not get the trough results before we hang the Vanco, and we no longer do peaks at all. The doses are adjusted by a pharmacist who's only job is to go to all the floors and adjust the high potency ABO's and he does this by the trough's. Usually we only here about the trough if it is a critical value then we would stop the vanco until further orders.
In this case the trough was high but not critically. The vanco was infusing already when I got it back. I was handing over the pt and we were all in report together. This fellow is great, but he has an argumentative manner, and is cocky, and you just have to argue back with him sometimes. He and I get along great. Then I went to my co-workers to see what they thought, and they agreed that they handled it the same way as I did. We agreed that maybe we need to bring this up to pharmacy, and management for a review of how we are handling this.
I've seen it done both ways. It's just what the docs at your facility like done. Currently where I work we draw the trough 1 hr before and wait for the results before we start the dose. Problem is; lab takes their time and harassing them doesn't help so we wind up drawing the troughs 1.5 hrs before so we have the results. I work with neonates so I think it's more important to make sure the level isn't toxic.
I liked it best at another facility I worked for that pharmacy took care of dosing IV aminoglycosides (with md order). They rarely did a traditional peak and trough. Most of the time they would order a 10hr post dose level and also a BUN/creatnine. They would plug those numbers into a computer program and it would adjust the dose (or not). They used very non-conventional doses and times; like Vanco 1275mg q30hrs; or Gent 135mg q16hrs (not babies; these were adults).
A question came up yesterday. At my facilty you get the trough right before the vanco dose, then start up the vanco dose. The peak was due to be drawn 1/2 hour after the dose was in. The doc had ordered it done on the 2200 dose. One nurse challanged me because I didn't hold the vanco until after the trough came back. He's worked elsewhere, I work with him in ICU, but this was a Med-Surg pt that I was handing over after 4 hours, after having floated.
Anyways he said that he always waits to start the vanco until after the trough is back, that it was protocol where he worked before. I discussed it with other co-workers and traditionally where I work we start up the vanco immediately, leaving the trough and peak for pharmacy and the doc to evaluate. I discussed it in the morning with yet another co-worker and we all agreed that perhaps we need clarification on this.
What is the policy where you work? Any opinions? We are going to bring up this question with pharmacy and our manager.
We do peak and trough on the 3rd dose. Trough is done 1/2 hour before the dose and peak 2 hours after it is done infusing. If there is something off about the trough, the lab will call and the dose will be stopped. We don't hold the dose for the results though.
I would think by definition you don't hold the dose, because you're doing peaks and troughs which are done right before and just after.
Currently we are doing troughs only just prior to the third dose and hold the dose until the troughs are back. Then we have individual paramaters as to whether to give the dose or not.
I think our hospital needs to try to have a policy. Currently it seems that it's haphazard depending on the doc. It's not often that the vanco trough happens to land on a dose that I'm giving, so honestly I don't deal with it often, and was just going by what has been traditionally done. In this case, it wasn't a pharmacy order, but a doctor one, and he specifically wanted a peak and trough done on that particular dose, with no further instructions.
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Vanco peak and troughs, what's your policy?
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