Vancomycin infusion after allergic reaction

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Has anyone been ordered to give Vancomycin after that pt already had an allergic reaction to it?:uhoh21: I took over care of an 18y.o. that was to get another vanco. infusion on my shift. The dr told me that he already had a reaction of Red Mans Syndrome and hives, along with pruitis. The dr. told me that I would premedicate the pt with benadryl before the vanco and to "have epi on hand in case of another allergic reaction." :eek: About half way through the vanco dose the pt presented with eyrthema, pruitis, and swelling to the lower eye lids. At that time I gave him the minimum epi. dose. An hour later his color had returned to normal. The dr. asked me if the pt had difficulty breathing before I gave the epi. He did not, I didn't think I should wait until his airway was compromised to take action. As it turned out, the pt. was fine and I was terminated. I need your opinions! Help!!!:crying2:

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Specializes in CMSRN.

Is something missing from the post? I would think if doc had orders for such and you administered under correct circumstances then all would be ok, at worst an opportunity for education. But termination seems odd.

Am I missing something?

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Has anyone been ordered to give Vancomycin after that pt already had an allergic reaction to it?:uhoh21: I took over care of an 18y.o. that was to get another vanco. infusion on my shift. The dr told me that he already had a reaction of Red Mans Syndrome and hives, along with pruitis. The dr. told me that I would premedicate the pt with benadryl before the vanco and to "have epi on hand in case of another allergic reaction." :eek: About half way through the vanco dose the pt presented with eyrthema, pruitis, and swelling to the lower eye lids. At that time I gave him the minimum epi. dose. An hour later his color had returned to normal. The dr. asked me if the pt had difficulty breathing before I gave the epi. He did not, I didn't think I should wait until his airway was compromised to take action. As it turned out, the pt. was fine and I was terminated. I need your opinions! Help!!!:crying2:

Is there more to this story?

It seems as if the jump from administering epi (I assume you had a proper order) to termination is quite the jump.....

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I took the dr. saying to "have epi. on hand in case of another allergic reaction" as an order. Turns out, according to DON, that having it on hand was just for my security. That seems ridiculous to me. Another nurse (A) that I talked to about the epi. told another nurse (nurse B)that I had planned on giving the pt. the whole vial IVP. It turns out that nurse B was the pt's aunt. She had a fit and went to nurse management and wanted something done. I don't know what all was said. I don't know if the dr. wanted me fired, or the other two nurses that involved themselves. I feel I was basically terminated because of a rumor. And why give a kid a strong medication like that since there was already an allergic reaction?

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Did you give it IVP?

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Absolutely not, I gave 0.3mg subcut. which is the minimum dosage for pt over 66lbs.;)

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Specializes in ICU/ER.

So what were you terminated for? Giving the epi? How was the order written? I have never seen an order for "have on hand" with out instructions on how to use it.

As far as the Nurse Aunt goes, was she taking care of the patient? Isnt that in itself (her getting involved with his medical care) a HIPPA violation? Maybe I am grasping here, but something seems entirely wrong about this situation....

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I took the dr. saying to "have epi. on hand in case of another allergic reaction" as an order. Turns out, according to DON, that having it on hand was just for my security.

this just doesn't make any sense.

of course you'd give the epi...

did the doctor write it as an order?

and you documented orders and your interventions in nurse's notes?

something seems really off here...

leslie

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i took the dr. saying to "have epi. on hand in case of another allergic reaction" as an order. turns out, according to don, that having it on hand was just for my security. that seems ridiculous to me. another nurse (a) that i talked to about the epi. told another nurse (nurse b)that i had planned on giving the pt. the whole vial ivp. it turns out that nurse b was the pt's aunt. she had a fit and went to nurse management and wanted something done. i don't know what all was said. i don't know if the dr. wanted me fired, or the other two nurses that involved themselves. i feel i was basically terminated because of a rumor. and why give a kid a strong medication like that since there was already an allergic reaction?

it's a setup of course. how the dr. manipulated you into thinking about epi as part of treatment modality for vanco induced anaphylaxis. he knew the risks and put you unwittingly on the raft headed for the falls.

lesson... anything squirrelly like this happens again, let the charge nurse take full responsibility. epi is a standing order for anaphylaxis resp distress may be a s/s of anaphylaxis. if you admin an epi dose per protocol, discontinued the offending vanco and notified your md... you did well. you may actually have averted outright resp distress. after each new dose of allergen, the body becomes even more acutely sensitive and responds more aggressively.

check your standing orders protocol, get your facts straight and meet with your don. don't shrink away. admit errors honestly but, represent yourself and your interests. nevertheless, it does sound like a hostile environment without the needed coworker supports. your nurse a & nurse b are bad people... beware. the don hasn't supported you either. why return?

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Red mans syndrome is NOT an allergic reaction to Vanco. It is a common reaction to it being given too FAST. I have seen it many times on people and even have experienced it myself when given IV Vanc for osteo. Vanc should be given over a minumum of 2 hours. I have seen where it has taken 3 hours or so to avoid red mans. Also if there is no compromised airway the Epi shuld not have been given.

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Specializes in ICU/ER.
Red mans syndrome is NOT an allergic reaction to Vanco. It is a common reaction to it being given too FAST. I have seen it many times on people and even have experienced it myself when given IV Vanc for osteo. Vanc should be given over a minumum of 2 hours. I have seen where it has taken 3 hours or so to avoid red mans. Also if there is no compromised airway the Epi shuld not have been given.

Yes this post has bothered me. I have hung vanco before and do recall it was to be run over 2 hours. I just out of curiosity looked up vanco and it does say exactly what you have stated before about the red mans. I wonder how fast the order was to run it.

I still think something is fishy with this story, I do not like how Aunt Nurse got involved.

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Red mans syndrome is NOT an allergic reaction to Vanco. It is a common reaction to it being given too FAST. I have seen it many times on people and even have experienced it myself when given IV Vanc for osteo. Vanc should be given over a minumum of 2 hours. I have seen where it has taken 3 hours or so to avoid red mans. Also if there is no compromised airway the Epi shuld not have been given.

What if the pt has life threatening hypotension - can I give epi? What if I supected hypotention and/or resp distress would ensue? Must you have resp distress to have anaphylaxis? What is anaphylaxis but a hypersentitivity reaction? What causes the reaction and why?

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