Vanco peak & trough times - page 3

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. by   Gompers
    Quote from TBLPN
    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.........
    Are you drawing your vanco levels from the same PICC the vanco was infused? Where I am, that's a big no-no - it can alter the results, giving falsely high vanco levels. We cannot draw any drug levels from any lines where that med was infused, unless there are multiple lumens and it's not the one that the vanco goes through.
  2. by   TBLPN
    At our facility we draw the trough (usually) just prior to hanging the vanc. We draw the peak an hour after infusion. If it finishes at 7 am we draw at 8 am. BUT we have a doc that specifies.......he wants the trough drawn one hour prior to infusion and one hour after.........that makes it pretty simple.
  3. by   ginger58
    Quote from alterson
    What is everyone doing about drawing peaks and troughs? !
    Whether it be an infant or an adult, 3 different hospitals draw the trough 30 minutes before the dose. Where I am now the pharmacist gets the lab value and adjusts the dose. Other places the NNP/neo have adjusted the dose. So, I guess I would find out who manages the dose and ask them.
  4. by   nursebuxom
    This week I had a discussion with the ID about this issue. The rules for vanc have changed it seems. They used to do a peak and trough to ensure that the level was not toxic, now the goal is to keep the level up.

    We draw ours one hour before hang time, and do not hang until lab results are back and if out of range, reported with orders given.

    Peak is drawn 30 minutes to one hour after completion of infusion. The infusion time varies with the dose ordered, but we have been told to make sure the iv will hold for the dose because if it takes too long to hang, the therpeutic benefit will be lost. We've also been told that if the site is lost during infusion (and another not immediately available), notify the pharmacy or the MD for orders on the remaining amount. Apparently, after a while, there is no point in running the remainder of the dose.

    Did that make sense?
  5. by   YHVHdaughter
    I've been working via an agengy at an acute care hospital. A Vanco trough was drawn on my patient (after only receiving one dose 12 hours prior) and I hung the Vanco within the next half hour after the lab draw. Apparently this is wrong? After the Vanco level came back high I was told I was supposed to wait until the Vanco level came back prior to hanging the dose. I've never done it this way. Firstly, I've never heard of drawing a trough prior to 72 hours after the first dose. Secondly, how often can one expect lab results back within 30 minutes? ~ Not very often! Is this standard procedure?
  6. by   ProfRN4
    It was always my understanding that the trough you draw before the dose will subsequently affect whether you give the next dose (not the dose you are drawing the level right before). If the doc did not wright "draw trough level at 12pm and hold 12pm dose" why would you hold it? Unless this specific institution has a policy stating you hold the dose that you are drawing the trough before, then you are not wrong (IMO).

    This is the problem with nursing; too many variations on things that should be standard
  7. by   betweenus64
    Again here I am about to be fired...I have written on more than one occasion the stuff that I have either learned or did wrong and learned from. I am here to tell you about hanging Vancomycin. Okay, 2 days ago I was told "verbally" a trough would have to be drawn on Wed. which was yesterday, I said okay. I went home, slept and came back to work, the MAR did not have any of this information on it about getting the trough before hanging the vanc but I did remember I was "verbally" told this and it was in the chart, not on the MAR. I am an LPN and have been a nurse 5 years without nursing home training yet I work here and am happy, or at least was until today. I did not hang the vanc and we did the labs, I went to work passing meds, answering call lights, etc and had a fall with all the stuff going on. The vanc was not hung because we have to wait for labs to come back, so I asked a nurse that was doing all the paperwork like charts and orders about the lab, she said, oh, we will get a fax when it comes back not to worry until then, so I did not. I did pass the message on to the next shift, no vanc hung etc. Today I got a call from my boss on my day off, yelling, saying to explain why I did not hang the vanc. I told her I was told the lab was not back and it was not on the fax when I left at 11:30 pm but I did ask about it and was told we can wait for the fax. The vanc was drawn at 4pm and the order for vanc is 4pm so when 7 pm came around either way, it was late to hang, yet I did not because of the levels could be harmful, I got in so much trouble today, stating I am getting wrote up again for another med error, by not hanging the vanc I missed a med. Well, I am so tired of taking the heat for things that I just don't have knowledge about. I told her I could not hang it and the levels were not back and with everything that happened with the fall and all I did not get the labs back. She told me I was responsilbe for calling the lab instead of waiting on a fax. I guess she is right on this one yet a nurse that has been licenesed longer told me not to worry then today I called her at home to tell her I was told they are now looking at my job performance. I would assume I am getting fired. I truly hate working for this company only because I don't suck up and am not their best friends and most of them are. I just want to do my job, do it well and learn, but I can't learn when they won't help me or teach me. I have asked questions but got smart elick answers leaving me not wanting to learn anything here. I am glad I did not hang the vanc, they are more pissed about that than if I had hung it and killed someone. I just can't win here and not sure what to do. So how do you get more experience on handling stuff? I am a great nurse, I just need experience and am tired of all the worry here. Any advice?
  8. by   IVRUS
    First of all, you absolutely MUST know your facilities policy on this. MOST LTC settings have infusion policies in place which stipulate NOT to hold the Vanc while waiting for the trough results to come back. LTC is totally different than Hospital settings. In a hospital, one is able to get trough results back fairly quickly, not so in LTC. So, the Vanc is given, and then if trough results come back too high, orders are obtained to hold the next dose for a time. Does your facility have a pharmacy which puts out an IV manual at intervals? If so, consult it for the actual P&P.
  9. by   FLorida_624
    My question is, i understand the time frame of drawing peaks and troughs, but not when. Say they want them with 3rd dose. So do i start with a trough before third dose, then a peak an hr after (making it basically a trough and peak right), or do i start with the peak after 3rd dose and basically get the trough before fourth dose?
  10. by   IVRUS
    Normally P&T are NOT done for Vanco, but they are done for your aminoglycosides (Tobra, Gent, Amikacin) . But when they are ordered, Trough is done at 0830 for a 9 AM dose and then Peaks for Vanco should be done 1-2 hours post infusion depending on the mg amount of the drug given.