Tobramycin trough & peak

annaedRN, RN · Mar 16, 2010

we routinely do 2 visits. get the trough, go do another visit then come back and get the peak and finish up what everl else needs done. depends on the insurance if 2nd visit is free one or not. often the docs will just let you do the trough if you call and ask...if everything is stable otherwise

AnnemRN · Mar 16, 2010

I guess it depends on the timing of the Tobramycin infusion. If possible you could get consents signed, collect the trough and deliver to the lab then go back to the home and initiate the admission while the infusion is going. Maybe complete other patients charting and then collect the peak when the infusion is finished.

It sounds like a lot of coordinating though, it may be easier to do 2 visits.

KateRN1 · Mar 17, 2010

What I've usually done in this situation is to first get consents signed, then draw trough, then finish assessment and paperwork, and draw peak once infusion is completed. It takes me a good hour or more to get through all the paperwork and the assessment for the admission. You should also watch your patient "hook up" to make sure that she is able to do everything correctly. I can't see a reason for two visits for a 30 minute to at-worst-case-scenario an hour long infusion. Oh, and make sure you have an order to draw labs from the PICC or do peripheral venipuncture if needed.

spejsa · Mar 17, 2010

Of course, I was trying to plan ahead and it didn't work out... I was gonna do tomorrow so then I would look at everybody's responses on here, but... patients' husband called office today to say he wanted nurse to come out and do today... ugghhh. So, I did draw the one right when I got there and then had her sign all paperwork and I did whole admission while the infusion was going. I am always there a good hour for admissions anyways... So, by the time I was done with all that, the infusion was done. yes, I watched how she hooked up, etc.. Then, I ran the labs to the lab.. I was just wondering also about how long you could have the meds sitting in cooler or out without getting to the lab? For, this kind of lab? I need to get a book that shows me how long I can have labs sitting there cuz I always worry about clotting and problems when you don't get them to the lab quick enough.. I didn't hear anything from the lab, so hopefully they were ok

AnnemRN · Mar 17, 2010

Of course, I was trying to plan ahead and it didn't work out... I was gonna do tomorrow so then I would look at everybody's responses on here, but... patients' husband called office today to say he wanted nurse to come out and do today... ugghhh. So, I did draw the one right when I got there and then had her sign all paperwork and I did whole admission while the infusion was going. I am always there a good hour for admissions anyways... So, by the time I was done with all that, the infusion was done. yes, I watched how she hooked up, etc.. Then, I ran the labs to the lab.. I was just wondering also about how long you could have the meds sitting in cooler or out without getting to the lab? For, this kind of lab? I need to get a book that shows me how long I can have labs sitting there cuz I always worry about clotting and problems when you don't get them to the lab quick enough.. I didn't hear anything from the lab, so hopefully they were ok

From a safety standpoint, our lab requires that you draw the trough first and deliver it. The reasoning is if the trough level is too high you may have to hold the current tobramycin dose and it's going to need to be adjusted. Tobramycin is nephrotoxic so, you have to be careful. The results are usually ready within an hour.