Vanco peak & trough times

Specialties Infusion

Published

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!

Specializes in NICU.

At our hospital, antibiotic trough levels are drawn 30 minutes before the med is due. We start the med at it's designated time, and then if it runs for 30 minutes, we do the peak 30 minutes after the infusion finishes. If it runs over an hour, like vanco, we do the peak an hour after the infusion finishes.

We don't wait for the levels to hang the medication. They will adjust the future doses if the peak and trough are off.

1
Up Vote Up Vote ×
Specializes in Inpatient Acute Rehab.

We do 30 minutes before for the trough and 30 minutes after for the peak.

1
Up Vote Up Vote ×

I work in home iv infusion and we draw troughs 30 min. to just prior to hanging the med., peaks are drawn 30 min to 1 hour. According to our pharmacists as long as you document the exact time the previous dose was given, time of the trough, time drug started and completed they can calculate a more accurate dosage. A bun and creatinine should drawn at least once a week as well.

1
Up Vote Up Vote ×

Trough within 30 minutes before the dose. Peak 60 minutes post dose. Silly that some don't do peak levels as the trough can be high but the peak low.

1
Up Vote Up Vote ×
Specializes in Pediatrics.

trough- Right before the dose

Peak (if they really want it) is 1 hr after completion.

One place I work at, we give the dose, and adjust subsequent doses. The other place, we hold it. Forgetting where I was, i hung the dose right after I drew the trough, and almost got my head bitten off!! Of course they didn't want to hear that at the other place I work, we adjust the next dose. So they wait to get the level. My thought was, now you're throwing off the tiems. Interestingly enough, the trough level came back in record time.

1
Up Vote Up Vote ×

After reading these posts, it seems that the times for peak and trough draws vary a lot. The best advice was to check your agency's policy and procedure manual; that's the standard that will be used in case of a problem, law suit, etc.

What jumped out at me was the nurse using the PICC line for the lab draw. Our home health agency strongly discourages using the PICC line for lab draws (not sure of the exact reason). We only use them if we can't get a stick anywhere else.

Cindy

1
Up Vote Up Vote ×
Specializes in Emergency, House Supervision, IV Therapy.

Varying times for the peak and trough; all are within good parameters for a protocol, most importantly, that your facility is standardized and follows the same routine for that test. I have usually seen the peak at 60 minutes after the infusion is complete and trough, just prior to starting the dose.

Now, my question for you. Just started at another facility, that has a rule, no one can draw peak and trough levels or coag studies from PICC lines. I have not worked anywhere else where anyone had a problem with this. As long as the line is flushed well using a turbulent push/pause method before the specimen is drawn. I have heard that some home health agencies will not use specimens from PICC's for these tests, but I need to have some data or reference to a study that says it is not a problem. Anyone have a reference?

We do not even use heparin anymore that would invalidate a coag study because we are using positive pressure claves on everything and only flushing with saline. What about the rest of you??

1
Up Vote Up Vote ×

Can anyone give me some step by step instructions on giving vanco? I needed to instruct the pt and well I am new in the teaching dept.

Thanks!!:)

1
Up Vote Up Vote ×
Specializes in Vents, Telemetry, Home Care, Home infusion.
Jonesy said:
Can anyone give me some step by step instructions on giving vanco? I needed to instruct the pt and well I am new in the teaching dept.

Thanks! :)

Your infusion dept should have a teaching packet for the patient as part of admission paperwork.

If they don't and after reading your previous post regarding Portacath issues you were not oriented/aware of, you need to carefully consider working for this home care agency, especially if small or new company as not equipping their field staff properly.

1
Up Vote Up Vote ×

I just did this this morning. The order was specific. Draw the trough one hour before running the Vanc and draw the Peak one hour after infused. At my facility lab doesn't draw from a Picc either. I'm an LPN and we do. I love it it's great.........

1
Up Vote Up Vote ×
Specializes in NICU.
TBLPN said:

I just did this this morning. The order was specific. Draw the trough one hour before running the Vanc and draw the Peak one hour after infused. At my facility lab doesn't draw from a Picc either. I'm an LPN and we do. I love it it's great.........

Are you drawing your vanco levels from the same PICC the vanco was infused? Where I am, that's a big no-no - it can alter the results, giving falsely high vanco levels. We cannot draw any drug levels from any lines where that med was infused, unless there are multiple lumens and it's not the one that the vanco goes through.

1
Up Vote Up Vote ×

At our facility we draw the trough (usually) just prior to hanging the vanc. We draw the peak an hour after infusion. If it finishes at 7 am we draw at 8 am. We have a doc that specifies he wants the trough drawn one hour prior to infusion and one hour after. That makes it pretty simple.

1
Up Vote Up Vote ×
+ Add a Comment