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:

[SuesquatchRN, BSN, RN]

We didn't check any levels.

[UM Review RN, ASN, RN]

OK, I'll give it a go.

As I understand it, a patient's blood level of Vanco will determine whether or not the Vanco is working. The Vanco level needs to be within range to kill the offending organism but not so high that it kills the patient's kidneys.

Peak level (highest serum concentration) is drawn about an hour or two after the infusion is completed. Trough (lowest serum concentration) is drawn about a half-hour before the scheduled dose.

I usually see a trough drawn a half-hour before the third or fourth dose and after that, random levels are drawn.

I always check with Pharmacy on questions like yours. Pharmacy usually looks at the labs and doses the patient in our hospital and they're very helpful.

[chocokitten]

OK, I'll give it a go.

As I understand it, a patient's blood level of Vanco will determine whether or not the Vanco is working. The Vanco level needs to be within range to kill the offending organism but not so high that it kills the patient's kidneys.

Peak level (highest serum concentration) is drawn about an hour after the infusion is started. (I think. Frankly, we don't get many orders for peaks.) Trough (lowest serum concentration) is drawn about a half-hour before the scheduled dose.

I usually see a trough drawn a half-hour before the third or fourth dose and after that, random levels are drawn.

I always check with Pharmacy on questions like yours. Pharmacy usually looks at the labs and doses the patient in our hospital and they're very helpful.

Ditto to the above, I gave vanco two days ago and i drew the trough level 30 minutes before admin time, then checked the results before giving it and notified the MD cause the level was a little high (he had me give it anyways).

[UM Review RN, ASN, RN]

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

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

[sonja77]

we usually draw labs with every 3rd vanco dose.

a trough is drawn 1 hr before the 3rd vanco dose, then we wait for the results come back from the lab. if the level is within normal limits we hang the 3rd dose, if it's too high we hold the dose and notify the physician.

the peak is drawn 1 hr after infusion of the 3rd dose.

[Conrad283, BSN, 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:

trough is the main level that is checked.

[Lorie P.]

when we have a pt on vanco, the order usually reads; for pharmacy to dose and depending on the labs levels, pharmacy will also lets us know to hold or give.

doc is notified if holding due to a high trough level. it can get confusing, also on the pt's mar, there will be a highlighted note saying trough level only before this dosage or peak & trough level needed at whatever time.

any questions, the rph is my best friend on 11-7 shift.

[SuesquatchRN, BSN, RN]

Wow. I was NOT taught this!

Thanks, all.

[ohmeowzer RN, RN]

pharmacy doses it, peak and trough on 3rd dose. also check labs BUN and creat to be sure their kidney's are tolerating it.

[jnrsmommy]

That's the way I was always taught too. The military facility that I was working at last year went away w/ vanc P&T, big old note from pharmacy on lab order saying that new data was showing that this was not an acceptable method for determining level, and there was a new test that we were drawing (just half hour before), but darned if I can't remember the name. Gonna have to call my friend when she gets to work tonight.

Back to the peak and trough. I've found it depends on the facility you work at. One hospital I've been to, they (meaning pharmacy) go off of the peak, while most others go off of the trough. I've just learned to check w/ pharmacy and let the doc know the results if anything is off.

[nyapa, RN]

We do trough levels. Every three days. We also check urea electrolytes and creatinine to determine renal status.