A question came up yesterday. At my facilty you get the trough right before the vanco dose, then start up the vanco dose. The peak was due to be drawn 1/2 hour after the dose was in. The doc had ordered it done on the 2200 dose. One nurse challanged me because I didn't hold the vanco until after the trough came back. He's worked elsewhere, I work with him in ICU, but this was a Med-Surg pt that I was handing over after 4 hours, after having floated.
Anyways he said that he always waits to start the vanco until after the trough is back, that it was protocol where he worked before. I discussed it with other co-workers and traditionally where I work we start up the vanco immediately, leaving the trough and peak for pharmacy and the doc to evaluate. I discussed it in the morning with yet another co-worker and we all agreed that perhaps we need clarification on this.
What is the policy where you work? Any opinions? We are going to bring up this question with pharmacy and our manager.
We do peak and trough on the 3rd dose. Trough is done 1/2 hour before the dose and peak 2 hours after it is done infusing. We don't hold the dose for the results.
We also do random draws.
Additionally, we are directed to give the Vanco on time as scheduled. I have yet had to hold a Vanco because the trough was too high. If lab were to call with a critical high trough I would stop it and CAll pharmacy.
Vanco is one of those drugs where pharmacy insist there be no deviation from giving it at the scheduled time. They insist if we are not able to give it well withing 30 minutes (at most)of the time it is scheduled we must call them.
The policy for this should be written by pharmacy.
A critical high trough to me would suggest a previous med error. I just have not run across this.
We do peak and trough on the 3rd dose. Trough is done 1/2 hour before the dose and peak 2 hours after it is done infusing. We don't hold the dose for the results.
Additionally, we are directed to give the Vanco on time as scheduled. I have yet had to hold a Vanco because the trough was too high. If lab were to call with a critical high trough I would stop it and CAll pharmacy.
Vanco is one of those drugs where pharmacy insist there be no deviation from giving it at the scheduled time. They insist if we are not able to give it well withing 30 minutes (at most)of the time it is scheduled we must call them.
The policy for this should be written by pharmacy.
Yes, this was precisely what the head of pharmacy told me.
Agnus
2,719 Posts
We do peak and trough on the 3rd dose. Trough is done 1/2 hour before the dose and peak 2 hours after it is done infusing. We don't hold the dose for the results.
We also do random draws.
Additionally, we are directed to give the Vanco on time as scheduled. I have yet had to hold a Vanco because the trough was too high. If lab were to call with a critical high trough I would stop it and CAll pharmacy.
Vanco is one of those drugs where pharmacy insist there be no deviation from giving it at the scheduled time. They insist if we are not able to give it well withing 30 minutes (at most)of the time it is scheduled we must call them.
The policy for this should be written by pharmacy.
A critical high trough to me would suggest a previous med error. I just have not run across this.