Vanco peak & trough times - page 3

by alarla

188,781 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


  1. 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.
    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'.
  2. 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??
  3. 0
    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!!
  4. 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.
  5. 0
    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 ...
  6. 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.........
  7. 0
    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.
  8. 0
    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.
  9. 0
    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.
  10. 0
    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?


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