critical vanco level, infused anyway

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    Hello....I work in a medical surgical unit. I received a critical vanco level of 30.2 . the dose was supposed to be given at noon. But because of the critical level Pharmacy said to infuse it at 1600, in other words four hours later. Dosing is being managed by pahrmacy protocol. Well I infused at 1600 like I was told. So then at 1600 I call pharmacy again with this pt's chem7 results and explained to the pharmacist that the previous pharmacist was needing the bmp results and also explained to him that I was told to infuse anyway by the previous phsrmacist 4 hours later. Well the current RPH told me to stop the infusion and asked how much had infused. It had infused about 75cc of 1250mg/250ml bag. Well now im worried that I did something wrong by still infusing the vanco under pharmacist direction even tho the vanc level was high. Anyone have any input as to how this situation should ve been handled? Please excuse my typos, im in my mobile. Also this was on an elderly pt.
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  3. 8 Comments so far...

  4. 0
    In the future I would also get a doctors order for the new time change to infuse. I am not sure if you did this. I think there is soooooooooooooooo much misunderstanding about aminoglycoside monitoring. Was there an order that said vanc per pharmacist protocol> ? I think that is a great order to cover you. I dont think you did anything wrong except to cover your bases and protect the patient it does not hurt to stay in communication with both the dr and the pharmacist. Perhaps in the future get the bmp results back and follow up with the pharmacist before hanging the next dose but I dont see that you did anything"wrong."
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    Yes, there was an order for vanco per pharmacy protocol. RPH didnt send a new order to infuse at 1600, this was just all verbal over the phone. Another thing is that this pt didnt not have any base line labs or anything. So when I got an order for bmp, I called the results to the 2nd RPH who was the one to said to stop infusion and draw vanco level with am labs. Then they woukd adjust accordingly.
  6. 0
    Sounds good...they should have done some baseline labs in my opinion but still that isn't always the case. Was this a random level or a trough right before the third dose? It could have been very high because of the time it was drawn if it was random..
  7. 0
    Also if that was a peak level that was in normal range...was it a random level or a trough??(i,e 30 min before the next dose is due)
  8. 1
    ok, now im in front of my laptop and can type better. they drew the vanc trough at 1100 before the 1200 dose. this wouldve been the 3rd dose. well the vanct was 30.2 . so when i called the RPH, he said that it might have been high because we were supposed to draw the vanT on the 4th dose, and it was drawn on the 3rd dose instead. so he said to just infuse at 1600 instead.

    well realistically, the 1600 dose was actually going to be given at 1800 due to another antibiotic infusing. so pharmacist said this was ok. well at 1800 when the bmp results came back, i called them in to pharmacy. 2nd RPH was the one that said to stop the infusion and was asking how much had infused. also said that it does not make any sense what the previous RPH said as an explanation as to why the vancT might have been high. he said if vancT was high, he shouldnt have said to give dose with vancT being that high. so now im worried...
    turnforthenurseRN likes this.
  9. 0
    Well I have resident on 250ml/2.5hr ATB and we get trough and creatinine every 2 days and when Vanco came back 21.7 per pharmacy request we needed to hold to doses 1900 and 0700 and get a trough at 0630 prior to 2nd dose hold. If it was still over 20 then pharmacy advised q24h. But I was always told phar out trumps DR!
  10. 0
    Pharmacy manages Vanc at my hospital, too, along with all of the protocols. Sometimes nurses do not check when a vanc trough will be due...so they hang the vanc and then the trough is done. Lab then calls with a critical result. This happened to one of our nurses recently. Vanc trough was due at 0530 and Vanc was scheduled for 0600. Nurse hung the vanc at 0500, trough was drawn afterwards, lab calls with a critical result >30 and a minute later the pharmacist calls asking when the vanc was hung. When he learned the vanc was hung before the trough was done, he stated "that was what I thought" and said to keep the vanc running and they will schedule another trough to be drawn before the patient's afternoon dose.
  11. 0
    For a pt getting vanco, how often is a trough level done?


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