Vanco peak & trough times - page 2

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... Read More

  1. Visit  melsay profile page
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    Ahhhh....I recently found out after being in a rush to see all my patients and one was due a Peak trough, bun and creat. that the protocol for our agancy was set my the pharmacist to make , and I quote "it easier for them to calculate any changes in the medications(Vanco)" I neede more than an hour to get back to draw the level, the pharmacist stated that as long as I stated on orders the EXACT time trough drawn and the Exact time Peak drawn they could calculate. Is our job not hard enough without making it "easier" for the pharmacist?? We draw Trough directly before starting Vanc, then 60 min after infusion complete we draw Peak...b/c we all know we need to make it easy for the pharmacist :chuckle
  2. Visit  Gompers profile page
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    At our hospital, antibiotic trough levels are drawn 30 minutes before the med is due. We start the med at it's designated time, and then if it runs for 30 minutes, we do the peak 30 minutes after the infusion finishes. If it runs over an hour, like vanco, we do the peak an hour after the infusion finishes.

    We don't wait for the levels to hang the medication. They will adjust the future doses if the peak and trough are off.
  3. Visit  unknown99 profile page
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    we do 30 minutes before for the trough and 30 minutes after for the peak
  4. Visit  jeene24 profile page
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    I work in home iv infusion and we draw troughs 30 min. to just prior to hanging the med., peaks are drawn 30 min to 1 hour. According to our pharmacists as long as you document the exact time the previous dose was given, time of the trough, time drug started and completed they can calculate a more accurate dosage. A bun and creatinine should drawn at least once a week as well.
  5. Visit  allenmob profile page
    0
    Trough within 30 minutes before the dose. Peak 60 minutes post dose. Silly that some don't do peak levels as the trough can be high but the peak low.
  6. Visit  ProfRN4 profile page
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    trough- Right before the dose

    Peak (if they really want it) is 1 hr after completion.

    One place I work at, we give the dose, and adjust subsequent doses. The other place, we hold it. Forgetting where I was, i hung the dose right after I drew the trough, and almost got my head bitten off!! Of course they didn't want to hear that at the other place I work, we adjust the next dose. So they wait to get the level. My thought was, now you're throwing off the tiems. Interestingly enough, the trough level came back in record time.
  7. Visit  cinnyluvscats profile page
    0
    After reading these posts, it seems that the times for peak and trough draws vary alot. The best advice was to check your agency's policy and procedure manual; that's the standard that will be used in case of a problem, law suit, etc.

    What jumped out at me was the nurse using the PICC line for the lab draw. Our home health agency strongly discourages using the PICC line for lab draws (not sure of the exact reason). We only use them if we can't get a stick anywhere else.

    Cindy
  8. Visit  ProfRN4 profile page
    0
    Quote from cinnyluvscats
    after reading these posts, it seems that the times for peak and trough draws vary alot. the best advice was to check your agency's policy and procedure manual; that's the standard that will be used in case of a problem, law suit, etc.
    [font="comic sans ms"]the op said there is no policy for this. i've been in threads like this before (i actually started one a couple of years ago- regarding something we didn't have a policy for). she was looking for 'what everyone does'.
  9. Visit  zannlee profile page
    0
    Varying times for the peak and trough; all are within good parameters for a protocol, most importantly, that your facility is standardized and follows the same routine for that test. I have usually seen the peak at 60 minutes after the infusion is complete and trough, just prior to starting the dose.

    Now, my question for you. Just started at another facility, that has a rule, no one can draw peak and trough levels or coag studies from PICC lines. I have not worked anywhere else where anyone had a problem with this. As long as the line is flushed well using a turbulent push/pause method before the specimen is drawn. I have heard that some home health agencies will not use specimens from PICC's for these tests, but I need to have some data or reference to a study that says it is not a problem. Anyone have a reference??

    We do not even use heparin anymore that would invalidate a coag study because we are using positive pressure claves on everything and only flushing with saline. What about the rest of you??
  10. Visit  Jonesy profile page
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    Can anyone give me some step by step instructions on giving vanco? I needed to instruct the pt and well I am new in the teaching dept.
    Thanks!!
  11. Visit  NRSKarenRN profile page
    0
    Quote from Jonesy
    Can anyone give me some step by step instructions on giving vanco? I needed to instruct the pt and well I am new in the teaching dept.
    Thanks!!
    Your infusion dept should have a teaching packet for the patient as part of admission paperwork.

    If they don't and after reading your previous post reagarding Portacath issues you were not oriented/aware of, you need to carefully consider working for this homcare agency, especially if small or new company as not equiping their field staff properly.
  12. Visit  NRSKarenRN profile page
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    vancomycin

    vancocin - vancocin side effects - vancocin information - canada ...
    precautions: vancomycin iv should be administered in a dilute solution over a
    period of not less than 60 minutes to avoid rapid-infusion-related reactions.


    guidelines for control of antibiotic resistant organisms

    vancomycin-resistant enterococcus (vre) infection control ...
  13. Visit  TBLPN profile page
    0
    I just did this this morning. The order was specific. Draw the trough one hour before running the Vanc and draw the Peak one hour after infused. At my facility lab doesn't draw from a Picc either. But I"m an LPN and we do. I love it it's great.........


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