Vanco peak & trough times

mommatrauma, RN · Jun 28, 2005

When I worked on the floor we did the trough just before the med was hung, and we did the peak 60 min after the med was finished infusing.

HillaryC, RN, CRNA · Jun 29, 2005

What is everyone doing about drawing peaks and troughs? At my LTC facility, we have a patient with a PICC. The lab does not draw from PICC lines so the RN has to do it. The patient gets Vancomycin at 8 am. Should the trough be done right at 8:00 or at 7:00 am? Same with the peak - the vanco infuses for an hour so should the peak be drawn at 9:00 or 10:00? And no, we do not have a pplicy for this. The DON, ADON, and manager were arguing but were unable to decide. I figured I'd ask here. Thanks for any advice!

At my facility, we do troughs 30 minutes before giving the dose, and peaks 30 minutes after the dose ends.

shopgal, RN · Jun 29, 2005

Yeah, our protocol is no more than 30 min before infusion and then a 30 min to 1 hour window after infusion. We always draw them 72 hours after the initial dose.

Home Health Columnist / Guide · Jun 29, 2005

If you have no policy, ASK THE DOCTOR WHAT HE WANTS!

In home care infusion, I usually drew trough 1 hour prior to start infusion, peak 1 hour after infusion finished. However, some docs wanted rough drawn immediately prior to infusion... rarely.peak as much as 90 hours post infusion if poor renal clearance. 72 hours after initial vanco treatment infrequently requested too.

Most important thing is to make a decision and stick with the times ---write on lab slip too how done so can be added to computer printout.

PeachyOrthoRN, RN · Jun 29, 2005

Our hospital's policy is 5-30 minutes before infusion for the trough and one hour after it's been infused for the peak. Hope this helps. :)

Tweety, BSN, RN · Jun 29, 2005

Our policy is within one hour prior. Give or take a few is o.k. The last several years we've stopped doing peaks and usually only do troughs. Occasionally the pharmacy will order a peak 12 hours after the first dose in hung. I'm sure this is evidenced based but don't have the resource.

Kudra · Jun 29, 2005

For those of you who draw blood work just before giving the dose: how long does it take your lab to run the vanco level? Do you hang the med before you know your lab results?

I use to go ahead and hang the med before I got the level back (usually the lab wouldn't come to draw the lab work until 5 minutes before the dose was scheduled... Then, of course, it would take a minimum of 30 minutes to get the lab work back which screws up your med schedule)... But the last time I did this, the patient ended up having a toxic level of vanco in his system... I stopped the infusion (he had gotten approx. 50 ml of a 250 ml bag), flushed the line and informed the charge nurse... The patient was fine, but obviously, I'm at fault because I hung the med without the trough level... I'll never hang vanco again without having my blood work back first...

PeachyOrthoRN, RN · Jun 29, 2005

In our hospital we go ahead and hang the dose. On may occasions the trough has come back critically high, and we have called the infectious disease doc's they just tell us that a trough is useless without a peak critically high or not, besides 9/10 times the peak comes back normal or even low and the doc's have to adjust the vanco dose anyway. Go figure!

Tweety, BSN, RN · Jun 29, 2005

We wait for the level. If it's less than 10 or 11 depending on the order we give it. :)

ladylynx · Sep 25, 2005

alterson said:
What is everyone doing about drawing peaks and troughs? At my LTC facility, we have a patient with a PICC. The lab does not draw from PICC lines so the RN has to do it. The patient gets Vancomycin at 8 am. Should the trough be done right at 8:00 or at 7:00 am? Same with the peak - the vanco infuses for an hour so should the peak be drawn at 9:00 or 10:00? And no, we do not have a policy for this. The DON, ADON, and manager were arguing but were unable to decide. I figured I'd ask here. Thanks for any advice!

Although this is an older post, I must have input because I am still not sure of the rationale. For the past year or so, Dr's, Pharmacist's and other nurses often get upset when Vancomycin is being held after the "random" troughs. Now, most places there are no "Peaks" required or ordered anymore (thank goodness for the records in the attorney's hands).

As for the "times" to draw, I have learned from working in various hospitals, that the most important answers you can get regarding peak and trough times, as well as how to flush an type of intravenous lines, etc. is all in the "Policy's and Procedure Manual". It doesn't matter what another nurse tells you, even though P & P are considered as guidelines (if an attorney asks you). Like "laws", these can be changed, but it keeps a little more consistency in place.

acosgro · Oct 3, 2005

Ask the long term care pharmacist for recommendations. I work for a long term pharmacy and many physicians ask the pharmacy to dose vancomycin and order the frequency of lab testing. Our pharmacists only recommend vancomycin troughs. The study literature reveals if troughs are within therapeutic range the peak will be okay. We recommend vancomycin troughs in the 30 minute window before the dose.