need info about IV vancomycin

[Ms.RN]

hi!!!

i need some info about iv vancomycin. do you check both patients peak and trough level, or do you just check the trough level? if patient is getting vanco two times a day, like 6am and 6pm, when do you check the trough level? if a nurse already administered vanco at 6am, does it effect the trough level when a nurse checks it at 530pm before administering vando at 6pm? what does trough and peak level indicate? thanks in advance. :bow:

[husker_rn, RN]

I was taught to check a peak and trough with the third dose with the time frames everyone else was ; we would wait for the trough before hanging the third and when we did random troughs would wait for those results as well. 10 was the high value assigned at our hospital; some docs would hold a dose, others would give until the level hit 16-17. I have seen one case of "redman syndrome" from a dangerously high level so was always careful with Vanco.

[pagandeva2000, LPN]

This is interesting, because I have never seen this done. I only did 6 weeks of med-surg, so, I was not exposed to this. However, this is a major coincidence, because a friend of mine went to an agency last week and had a question on something like this for her pharmacology exam. I think it was asking which drug needed peaks and troughs done, and I remembered reading and being tutored to apply this to some of the stronger mycin drugs. Thanks for making me remember this!

[pagandeva2000, LPN]

Found a good website that explains a bit better than I did:

http://www.labtestsonline.org/understanding/analytes/vancomycin/test.html

Oh...thank you, thank you, thank you for this site! I plan to use this web site at work!

[GeminiTwinRN, BSN]

I agree with the P & T's being drawn around the 3rd dose, at the times posted already.

However, sometimes a peak is not done and if you think about it, if the trough is WNL then we automatically can assume that the peak is as well. Of course, for the initial vanc cycle, both peak and trough need to be checked at that 3rd dose. The trough only is checked when you're getting into someone who is on vanc for longer periods, like 14 days, etc.

And our pharmacy also doses and follows. :)

[jnrsmommy]

I agree with the P & T's being drawn around the 3rd dose, at the times posted already.

However, sometimes a peak is not done and if you think about it, if the trough is WNL then we automatically can assume that the peak is as well. Of course, for the initial vanc cycle, both peak and trough need to be checked at that 3rd dose. The trough only is checked when you're getting into someone who is on vanc for longer periods, like 14 days, etc.

And our pharmacy also doses and follows. :)

Not always true. The last dose of Vanc I gave about a week ago, the trough was well wnl, but the peak was off the chart (never saw it that high before, 66 point something). This pt was not renal impaired, this was actually his 6th dose of vanc. I'm glad I held the dose while waiting for pharmacy (who was backed up) for over 2 hours to get results. My charge had told me to go ahead and hang it, told her I didn't feel comfortable doing it w/o the results.

[danissa, LPN, LVN]

We also check peak and trough, half hour - 1 hour prior and one hour after third dose of vanc. (in the NICU) Prior to the second dose being given, U&e's are checked, and if ok, then dose is given.

We do this for Gentamicin as well, (which along with Benpen is our first line prophylaxis)

[nyapa, RN]

While we do trough levels, as mentioned previously, for some reason our lab documents on the results, that peak levels are not useful. Interesting the different points of view? Obviously there is no standard requirements. Personally, I'd like someone to watch my kidneys health with a drug like that as much as possible...

Re: Gent, we do troughs on that too. In fact I think the lab is more worried about gent than vanc

[Dixiecup]

I work in LTC and amazingly we do quite a bit of vanc. We always do the P&T before every third dose and then the pharmacy adjusts the dose accordingly.

One thing I have learned though....most of our people are older (naturally) and usually have a central line. The lab people always want the nurse to draw the level out of the port. this is not accurate! It seems like no matter how long you wait the blood has not circulated long enough and you get an innacurate level, so I always refuse and make them draw peripheral.

I have also seen patients with a critical high vanc level and you certainly do not want to continue to infuse, they are pretty much out of their head, so the peak and trough is very important in my opinion.