vancomycin - page 2
by fati_ER_RN | 8,250 Views | 19 Comments
Does anyone know if administration of cold vancomycin causes seizure?... Read More
- 0Aug 17, '11 by MassED GuideQuote from fati_ER_RNthe med is refrigerated.... so.....Well i never heard of vancomycin causing seizures. The reason am asking was cause i was hanging vanco as per our hospital protocol. As one of the rn past by said "you are not hanging thtat cold are you, it can cause sz on your patient". I looked all over online, medication books, and nursing books. So i don't know what he's talking about, just wanted to know if anyone had every heard that before.......thanks
- 0Aug 17, '11 by MassED GuideQuote from danh3190ours is in 250 ml bag given over 1 hour.... that's for 1gram.... if it's 1500 mg our pumps require it to go in over > 90 minutes...I usually hang it cold as we store it in the refrigerator till needed. Never heard that there was a problem and never had a problem.
Our infusion rate is usually 100 mL/hr which is less than 2 mL/min. Since it is traveling up the arm to the vena cava I'd be willing to bet that the med is body temperature by the time it hits the heart, much less the brain. By the end of the 2 hour infusion the med itself is probably near room temp.
- 0Aug 17, '11 by FribbletQuote from loriangel14I'm pretty sure if you can give it cold IV without the risk of seizures, then giving it orally will not cause any problem either.How about when you give it orally? We keep it in the fridge and give it orally right from the fridge.
But then again, I used logic to arrive at that conclusion....
- 0Aug 17, '11 by DavidFRIs there actually a need to store vanc in the fridge? It's common in France to give vancomycin in a syringe pump over 24 hours, hence one assumes it's stable at room temperature.
I've never heard of seizures with vanc in over 20 years of using it. As for giving IV's cold, many chemotherapies (e.g. navelbine, endoxan etc.) are stored in the fridge and we just take them out about 30 minutes before administration. Even with that, they're not exactly warm when they go up, however I've never had a problem giving a "cold" med, though I do always prefer that 30 minutes warm up time.
- 0Aug 17, '11 by 1968cowgirlGiving a cold med IV can cause painful vasospasms. This is what we were taught in school. Then I had to go into the hospital and received Zosyn IV for 3 days. I fussed about the spasms and it being too cold and to slow the rate down, nothing helped. And it was very painful. Then I noticed where the IV pump was setting the A/C was blowing directly on the bag. I like it cold so the A/C was low. The next hanging I asked them to please move the pump and I never had another problem. That was just my personal experience.
- 0Aug 17, '11 by merleeGave a lot of Vanco when I was in acute dialysis. Never saw seizures, but did see Red Man more than a few times. We then gave aceto/diphenhydramine on the spot, and as a premed whenever those pts needed recurrent dosing.
And we always started it fairly slowly for 15 minutes.
But no seizures.
- 1Aug 20, '11 by Esme12, BSN, RN Senior ModeratorQuote from as1234no....cold will not cause shock to the body causing seizures with a cold iv fluid......unless the liquid is liquid nitrogen...
cold may cause shock to the body, therefore causing seizure.
it is the rate by which vanco is infused that can cause reactions and seizures..........the rate (how fast) that causes rections........
rapid bolus administration (e.g., over several minutes) may be associated with exaggerated hypotension including shock, and rarely, cardiac arrest.
red man syndrome is a reaction to the drug vancomycin. patients typically develop symptoms within 5 or 10 minutes of receiving the drug, and they experience itching and flushing of the face, neck, & torso. they may also experience swelling of the lips, face, or eyes and/or a drop in bloodpressure, but this is less frequent. red man syndrome is not a true allergy, even though the symptoms look similar to an allergic reaction.
when signs of red man syndrome appear, the first step is often to stop the vancomycin infusion. some patients may receive antihistamine medications before the drug is restarted. it is common practice to infuse the vancomycin at a slower rate thereafter. if the drug is given again, red man syndrome can usually be avoided by pre-treating the patient with antipyretic and antihistamine medications (like acetaminophen and diphenhydramine) and infusing the drug at the slower rate.
vancomycin hydrochloride for injection, usp should be administered in a diluted solution over a period of not less than 60 minutes to avoid rapid-infusion-related reactions. stopping the infusion usually results in a prompt cessation of these reactions.
ototoxicity has occurred in patients receiving vancomycin. it may be transient or permanent. it has been reported mostly in patients who have been given excessive doses, who have an underlying hearing loss, or who are receiving concomitant therapy with another ototoxic agent such as an aminoglycoside. vancomycin should be used with caution in patients with renal insufficiency because the risk of toxicity is appreciably increased by high, prolonged blood concentrations
there have been reports that the frequency of infusion-related events (including hypotension, flushing, erythema, urticaria, and pruritus) increases with the concomitant administration of anesthetic agents. infusion-related events may be minimized by the administration of vancomycin as a 60-minute infusion prior to anesthetic induction.
during or soon after rapid infusion of vancomycin patients may develop anaphylactoid reactions, including hypotension, wheezing, dyspnea, urticaria, or pruritus. rapid infusion may also cause flushing of the upper body ("red neck") or pain and muscle spasm of the chest and back. these reactions usually resolve within 20 minutes but may persist for several hours. such events are infrequent if vancomycin is given by a slow infusion over 60 minutes. in studies of normal volunteers, infusion-related events did not occur when vancomycin was administered at a rate of 10 mg/min or less.
renal failure, principally manifested by increased serum creatinine or bun concentrations, especially in patients administered large doses of vancomycin, has been reported rarely. cases of interstitial nephritis have also been reported rarely. most of these have occurred in patients who were given aminoglycosides concomitantly or who had preexisting kidney dysfunction. when vancomycin was discontinued, azotemia resolved in most patients.
a few dozen cases of hearing loss associated with vancomycin have been reported. most of these patients had kidney dysfunction or a preexisting hearing loss, or were receiving concomitant treatment with an ototoxic drug. vertigo, dizziness, and tinnitus have been reported rarely.
reversible neutropenia, usually starting one week or more after onset of therapy with vancomycin or after a total dosage of more than 25 g, has been reported for several dozen patients. neutropenia appears to be promptly reversible when vancomycin is discontinued. thrombocytopenia has rarely been reported. although a causal relationship has not been established, reversible agranulocytosis (granulocytes <500/mm3) has been reported rarely.
i hope this helps.....