Vanco peak & trough times - page 2

by alarla 193,046 Views | 31 Comments

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... Read More


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    We wait for the level. If it's less than 10 or 11 depending on the order we give it.
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    Quote from 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!
    Although this is an older post, I must have input because I am still not sure of the rationale. For the past year or so, Dr's, Pharmacist's and other nurses often get upset when Vancomycin is being held after the "random" troughs. Now, most places there are no "Peaks" required or ordered anymore (thank goodness for the records in the attorney's hands).

    As for the "times" to draw, I have learned from working in various hospitals, that the most important answers you can get regarding peak and trough times, as well as how to flush an type of intravenous lines, etc. is all in the "Policy's and Procedure Manual". It doesn't matter what another nurse tells you, even though P & P are considered as guidelines (if an attorney asks you). Like "laws", these can be changed, but it keeps a little more consistency in place.
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    Ask the long term care pharmacist for recommendations. I work for a long term pharmacy and many physicians ask the pharmacy to dose vancomycin and order the frequency of lab testing. Our pharmacists only recommend vancomycin troughs. The study literature reveals if troughs are within therapeutic range the peak will be okay. We recommend vancomycin troughs in the 30minute window before the dose.
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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
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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.
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    we do 30 minutes before for the trough and 30 minutes after for the peak
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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.
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    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.
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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.
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    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


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