MICU/SICU - Vancomycin -peek and trough

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OK, can anybody explain to me when to draw labs(at what exact times) for vanco peek and trough? Why is this antibiotic so complicated to deal with...From what I understand, 30 minutes before you are ready to administer it, you draw trough. Then 15 min after, you draw peek? Thank you...........:redbeathe

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Specializes in Pediatrics.

I think it's varying between hospitals so you should definitely check your facility's P&P. At our hospital, the trough is drawn 30 minutes before the vancomycin is started and the peak is drawn 30 minutes after the vancomycin is completed.

I would think it would depend on your hospital b/c the values for "normals" would be different depending on when in the infusion process your hospital has you draw the labs...e.g. the peak would be higher 15 minutes out than 30 minutes out.

does that make any sense?

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In most cases, doctors are more concerned with the trough. In my experience, if the trough is greater than 15, the doctor usually holds that dose (and possibly orders another vanc trough level) until it is less than 15. In some cases, the doctor will decrease the dose or frequency. If the trough is too low, the vancomycin dose will be increased or the frequency. The trough basically tells you how much vancomycin is left in the system before a next dose of vancomycin. You want this to be a certain level to be effective. Vanc troughs are definately important to obtain in renal patients bc vancomycin can be toxic. Hope this helps.

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Specializes in Family Practice, Mental Health.

At my facility, the doc's order 'Vanco per pharmacy protocol'.

The pharmacy doses the vancomycin according to the current creatinine and adjusts the dose, if warranted, after the trough is drawn 30 minutes prior to the third dose. I haven't drawn a peak in....gosh, I can't remember the last time I drew a peak level.

Hope that helps.

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Specializes in Cardiac.

Ditto to the above. We only draw troughs 30 mins prior to the 3rd dose (no peaks drawn)

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Specializes in CCU,MICU,SICU,CTICU,Renal, Recovery.

Ditto as above. But have seen troughs done more frequently on renal patients to determine when to give the next dose...

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Specializes in gen icu/ neuro icu/ trauma icu/hdu.

We've been running on random vanc's for several years now used to to peaks and troughs now just do troughs approx 1-2 hrs prior to next dose. Though there seems to be an algorythm for bloods taken a little earlier.

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Specializes in Nursery, L&D, PICU, SICU.

In my facility the trough is drawn 30 minutes prior to the dose being due and the peak is drawn one hour after completion of the dose. The generic rule of thumb for us is to draw the peak the same number of minutes after completion as it took to infuse it. If you gave the drug over 30 minutes draw peak 30 minutes after complete, etc.

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Specializes in Cardiac.

Vanco is given over 2 hours. I've never heard of a peak being drawn 2 hours after (of course, I haven't drawn a peak on anyone in years and years...)

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Specializes in CCU,MICU,SICU,CTICU,Renal, Recovery.

Me neither. Random maybe...

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Specializes in Nursery, L&D, PICU, SICU.

Like I said we draw our vanc trough 1 hour after complete but the generic rule still is handy

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Specializes in Not too many areas I haven't dipped into.
Ditto to the above. We only draw troughs 30 mins prior to the 3rd dose (no peaks drawn)

I was about to say this...but you said it for me...lol

We also draw a lot of random vanc levels.

Back about 5 years ago, we were peaking and troughing ourselves to death, but it seems to be going out of vogue in our neck of the woods.

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