vancomycin in end of life?

Please help a new nurse out....

Worked a shift a few days ago on a unit I had never been on before. One of the patients was on hospice and expected to pass soon. She was ordered IV vancomycin 200mL over 60minutes. I hung the med, and set the rate at 200mL/hour. A little while later, I was working at the nurses station, and the patients family-friend approached and asked to speak with the nurse. I said I was the nurse, and she started blasting me about the IV rate! She said she was a end of life nurse (note: NOT this patients hospice nurse, just a friend), and that rate was WAY too fast, it needed to be run around 50-75mL/hour, and if I left it at 200mL/hr, the patient would "blow/swell up".

Of course, I was a little freaked out when I heard this, so I went to the room and examined the vanco bag, where the label clearly read 200mL over 60 minutes. I checked the physicians order and it also gave this dose/rate. To be on the safe side, I decreased the flow rate because the friend was absolutely adamant.

Anyway, now that I have a little free time to investigate... I am wondering what she was talking about?? I didnt see anything about this in my drug guide, except not to exceed 10mg/min. As far as I am aware, the patient did not have renal problems.

Please tell me if I am missing something critical here... or if the friend was misinformed??

eta: cannot remember the mg dosage at this time, sorry!

You did nothing wrong with the information you provided here. Vancomycin should run over at least 60 minutes, and I advocate that it should run over 90 minutes if you are giving over a gram of vanc. Though you didn't mention the mg, or gram amount, the key is to remember Vancomycin running in too quickly can cause "red neck, or red man syndrome" In this, the patient may develop a rash, pruritis and become hypotensive as histamine is released into the bodies system. Also remember that Vancomycin can be not only nephrotoxic, but also ototoxic.

I would have asked that friend/family member where they got their medical training and went about my business taking care of the patient as per the orders.

She must have been worrying about fluid overload, but probably just focusing on details instead of the overall picture.

You did nothing wrong...I question the fact that this hospice patient is being given ATBs. What is that doc thinking?

Hospice doesn't mean do not treat. Sure a patient can have abx.

I sure as heck wouldn't set a rate per a visitor. That, you did wrong! Don't do that anymore.

:)

Did the patient's friend know that you were just running a med for 1 hour, and not giving the pt 200 ml/hr of IVF continuously?

In any case, I agree with others who said they would not change the IV rate based on what a visitor said.

The friend was probably worried about either fluid overload (if she thought you were running fluids at 200cc/hr) or blowing the IV access (which is easy to do because Vanco is terrible for veins, especially peripheral access). Your dose was probably 1 or 1.5g and running it over an hour is pretty standard, although I usually run it over 90 minutes to save IV's. In any case, the friend was probably misinformed or not used to standard hospital Vanco administration.

I also normally run vanc over 1.5-2 hours to avoid/prevent red man, but 1 hour is the manufacturer recommendation.

Not sure what the visitor was worried about.

Unless the patient is on the verge of fluid overload this is a small amount of fluid and the rate isn't even that high. How to deal with a "colleague" who is freaking out is another matter.

The dose rate was set by pharm, it was completely within parameters, why the heck would you change therapy to appease a family member? Your pt. is who you are treating.

EXPLAIN to family, explain AGAIN to family; then order them out of the room if THAT's what it takes to deliver quality care.