How to run vancomycin by iv

morte, LPN, LVN · Jul 2, 2010

it should come from the pharmacy premixed. It should be given via central/picc, if possible. If given via peripheral IV, needs to be diluted more. Therefore the pharmacy needs to know what the IV access is.

And you need a pump. Good luck

iluvivt, BSN, RN · Jul 4, 2010

I hope you have a pharmacist to mix this for you...do you? Here ARE SOME KEY POINTS TO KEEP IN MIND.

1. Is usually administered as a partial fill/mini bag

2. It has a low Ph so yes if you have a central line use it...if not assess the vein frequently as the Vancomycin can be very irritating to peripheral veins

3 Must be administered over at least one hour otherwise the patient may become hypotensive or experience what is called "red man syndrome". If a patent experiences red man syndrome it is not always necessary to try another abx...in those cases administer an antihistamine as prescribed and administer the Vanco very slowly

4. Can be nephro and ototoxic so get trough levels as ordered and do not ignore symptoms that could indicate toxicity. The elderly can be very sensitive and may need increased monitoring. Check the drug level and monitor the pts creatinine

5 If pt will be on it for more than 6-7 days advocate for a PICC line to be placed

dblpn · Jul 4, 2010

I hope you have a pharmacist to mix this for you...do you? Here ARE SOME KEY POINTS TO KEEP IN MIND.
1. Is usually administered as a partial fill/mini bag
2. It has a low Ph so yes if you have a central line use it...if not assess the vein frequently as the Vancomycin can be very irritating to peripheral veins
3 Must be administered over at least one hour otherwise the patient may become hypotensive or experience what is called "red man syndrome". If a patent experiences red man syndrome it is not always necessary to try another abx...in those cases administer an antihistamine as prescribed and administer the Vanco very slowly
4. Can be nephro and ototoxic so get trough levels as ordered and do not ignore symptoms that could indicate toxicity. The elderly can be very sensitive and may need increased monitoring. Check the drug level and monitor the pts creatinine
5 If pt will be on it for more than 6-7 days advocate for a PICC line to be placed

Thank you so much for the pointers. i did get the vanco from the pharmacy and administered to my patient. thank God he had a picc line. i was so nervous giving this drug... i think i stood in his room for about 20 mins after start to make sure he was ok.

iluvivt, BSN, RN · Jul 5, 2010

sounds like you did fine..just administer over at least an hour and if the patient gets a hypersensitivity reaction....STOP the medication but keep your line patent (flush it)..check your protocol and see if you can give an antihistamine if needed and other meds do help so see if ou have an allergic/hypersensitivity proto ol in place as well OK

accessqueen · Jul 7, 2010

Duriing vanco tx trough levels must be drawn. They used to be before the third dose, our pharm is now doing before 4th dose. Therapeutic levels have changed as well. If the pt is MRSA the recommendations have become 15-20. Other infections the level can be 10-15. If the levels aren't therapeutic the dosage may need to change. We are doing more and more vancos q12 hours, or switching to daptomycin (esp for outpatients).

joannechuvalo · Aug 5, 2010

hi all..i realize this post is late, but i know it will be of some use to someone researching vanco. I was a RN for 25 yrs...and left the ER about 8 yrs ago, now working with my own company called Fight Against Drugs. I am physically fit and preparing to go to Haiti and have been working out in the gym almost daily, as i leave sept. 15...i had a tiny splinter removed from my finger and had cleaned it well and always use the hand sanitizers..A girl in the change room mentioned mrsa to someone on the phone she was speaking with and i noticed blisters on her hands..I mentioned that she should read up on this, take the precautions and informed the gym. The following day, the entrance to where this splinter had been removed was red and tender...I went to see a Dr at a medical clinic and explained my situation. I was told to use fucidin cream, which i was opposed to..wanted something strong and oral like keflex. I was told i was over reacting. 2 days later, i was in ER and started on vanco...peripherally..it burns. At first I thought it had gone interstitial but was told it was insitu. I was put on home care and during my week on vanco had my site changed 4 times, due to redness, pain and phlebitis. I asked the ER doctor to use picc line due to the pH of the drug and was told that i would have to go to x ray...The heat was radiating off my arm from an inch away. It was restarted in my right arm and by this time, i was given i gm. q12h....after the 2nd dose, that site too was too painful and i took it out..Almost a week later, i went to my own family Dr and now have both arms wrapped and am dealing with a burning acid feeling under my skin. I am documenting the pictures now for legal reasons, so if anyone cares to see what vanco can do in a healthy 54 yr old woman, email me and i will be happy to show you...Take it from me...do your patients a favor and do NOT give this peripherally...they wont thank you for it...The infiltration pain was unbearable..and i began a FB page called mrsa and superbugs if anyone cares to look...I was a nurse and pt. comfort was always important...this drug does nothing but cause agony if given peripherally...Joanne

esther tse · Oct 8, 2010

For IV vancomycin, we dilute in 20cc 0.9%normal saline, then we will run with microdrip chamber 100cc 0.9% Normal Saline then run for 20min++. Is it advisable?

IVRUS, BSN, RN · Oct 8, 2010

For IV vancomycin, we dilute in 20cc 0.9%normal saline, then we will run with microdrip chamber 100cc 0.9% Normal Saline then run for 20min++. Is it advisable?

Is this advisable... NO.

As Iluvivt explained in a previous post (See above), Vancomycin should NEVER be given in any time frame less than 1 hour. We actually run it over 90 minutes, if it is over a gram.

You need to avoid Redneck, or Redman syndrome, which is what can occur if this drug is given too quickly. 20 minute is ridiculous! Doesn't your pharmacy send it to you with instructions for use on the label?

Asystole RN · Oct 9, 2010

For IV vancomycin, we dilute in 20cc 0.9%normal saline, then we will run with microdrip chamber 100cc 0.9% Normal Saline then run for 20min++. Is it advisable?

As policy we dilute each 500mg dose with 100ml NS or 5mg/ml. Rate of 10mg/min.

Why are you not consulting your pharmacy or drug guide?