Vanco Trough Advice

Esme12, ASN, BSN, RN · May 22, 2014

Thread moved for best response.

For me it depends on the patient and the history of the patient...but I would probably hang the vanco. If I didn't I would all the MD and ask their preference....AND I would bug lab.

amhtmh · May 22, 2014

Thanks :)

Esme12, ASN, BSN, RN · May 22, 2014

If they have a history of renal impairment/insufficiency I wouldn't give it. It is only the 4th dose so...they are still building up a level. I would bug lab like crazy...there should be a policy that states what to do if.....

When IN doubt call the MD...they might get annoyed but who cares. I'd rather have them be annoyed because I called than screamed at because I didn't.

Asystole RN · May 22, 2014

You need to consult your pharmacist and/or MD and ask them what they want you to do, preferably the pharmacist.

There are some pretty good graphs that do a fairly good job at predicting trough levels based on the BS or Ht/Wt and SrCr so they should have at least a good idea of what range it will be in.

I have always drawn a SrCr with every trough and those tend to come back rather quickly and will give you a really good idea of what range to expect.

There are only a few patients I have ever held vanco pending trough results and those were all renal patients with very tight trough levels and high (relatively) doses.

If you are worried about toxic levels in your patient then assess for toxicity.

aortas · May 23, 2014

Consult with the ordering physician and go from there.

aortas · May 23, 2014

Because USUALLY the next dose is held pending the results but NOT ALWAYS. I have also given the same ordered vanco after the level was drawn as ordered by the physican and then when the results were available the order changed or stayed the same.

Home Health Columnist / Guide · May 23, 2014

[h=3]VANCOMYCIN DOSING AND MONITORING IN ADULTS[/h]

amoLucia · May 23, 2014

It's one thing if you're in a hospital and have easy lab access. But in LTC, it takes a while to get results as the lab tech continues to do facility pickups and then return to their respective hosp lab. We usually get results timely enough, but not enough to wait & hold a dose.

And we usually always do troughs AND peaks.

Cinquefoil · May 23, 2014

This question is exactly why my hospital has a clear policy stating that when vancomycin is given, the pharmacist will decide if the vancomycin should be given or held while the trough value is being processed. Then, whatever they decide goes into the vanco order set.

Because....I'm not a pharmacist!

Sure, I know vanco can be nephrotoxic, and can cause Red Man Syndrome, and is very painful when extravasated. And I can look up more, very quickly. But I do not have the depth and nuance of knowledge a pharmacist has.

Does your organization have any pharmacists whose brain you can pick?

caroladybelle, BSN, RN · May 23, 2014

I work in a teaching facility, so I can either discuss it with pharmacy or the resident.

However, if those are not accessible, it depends on the patient, the previous labs and the situation. If the pt is elderly, renally impaired, or getting chemo/several nephro toxic agents, I may wait for the level or a creatinine to guide me.