Vancomycin thru a Picc

[0911]

Red man syndrome is rate related, but is kidney function related to the rate of administration?

Our Pharmacy is having us give 2 gms or greater over 2 hours. Can it be given faster thru a PICC if the patient tolerates it without redman?

[AggieNurse99, BSN, RN]

Both hospitals I work at draw Vanc Troughs and titrate the dose. The dose is calculated by the pharmacy and is based on creatinine/creatinine clearance.

From online.lexi.com "Renal Impairment

Vancomycin levels should be monitored in patients with any renal impairment:

Clcr >50 mL/minute: Start with 15-20 mg/kg/dose (usual: 750-1500 mg) every 8-12 hours

Clcr 20-49 mL/minute: Start with 15-20 mg/kg/dose (usual: 750-1500 mg) every 24 hours

Clcr

I think once I gave a 750 mg vanco dose in 1 hr; 1 - 2 gms usually we go 1 1/2 hrs, 2 gms and over is 2 hours and over.

[iluvivt, BSN, RN]

You should NOT change the recommended rate of administration whether use use a CVC, such as a PICC or a PIV. Red man syndrome can occur even if you follow the recommended rate of administration . I have seen it often during the last ten min of the infusion and even after the dose has been infused. The nephrotoxicity is due to the peak and trough levels of the drug. Also you need to closely monitor any pt receiving any other drugs that also cause nephrotoxicity, such as the aminoglycosides.