Vancomycin infusion after allergic reaction

Nurses General Nursing

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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:

Also if there is no compromised airway the Epi shuld not have been given.

Epinephrine Injection

"You should use it when you are experiencing or are likely to experience a serious allergic reaction."

http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a603002.html

leslie

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Was there actually an order written somewhere for the EPI? SO sorry this is happening!

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I have seen 1gm vanco ordered to infuse over 1 hour and 1.5 over 90 minutes many, many times in homecare. Red man is a syndrome, not a allergic response. But, for someone who has had a true allergic reaction, I can understand why you gave epi. Seems to me that no matter what you would have done, nurse a and b might have still been involved. I agree with calling your don for something like this next time, let them earn their pay. As for you, I say move on!! Not that you can ever trust anyone in this world, but that place seems dangerous.

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Thank you to everyone who has responded to my problem with the epi/vanco. I feel there is still something wrong also. I feel I was basically fired because nurse Aunt must have freaked out thinking I gave the pt the whole vial of epi which I never did. Yes, I think nurse A violated HIPAA. Nurse aunt has been with the hospital for over 20yrs and I am a fairly new nurse, having been there 1 1/2yrs. I don't know if that even matters. I do have some questions myself. Why should we wait till the airway is compromised to intervene? Isn't maintain airway a #1 priority? Remember, I also said the pt had hives(with the first infusion), redness, itching, and swelling to the lower eye lids during the infusion I adm. I infused the vanco over 3hrs., and it was a 1200mg dose which seemed aggressive to me. I did not call the dr, I know I should have. He was coming in to the hospital in a few hrs so I thought I would talk with him then. I thought he gave me a V.O. for the epi and just forgot to tell me the dosage. It wouldn't be the first time a dr. had done that. Also, there are NO standing orders at this hospital. It seems the drs. like to micro-manage everything. I made some mistakes that I really regret, I forgot to CMA! It was a busy, crazy, shift. BTW, the dr. signed the order in the morning, just said that he wished I would have called him. I apologized and told him if he had a problem that "lets talk about it now." He seemed fine with everything. My friends are telling me to get a lawyer. I'm hesitating, I don't want to be black balled for all future job opportunities. What do you all think?

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if you are considering suing for wrongful termination, then obviously you'd need a lawyer.

if you want to obtain a good reference from them, perhaps a lawyer could help negotiate something on your behalf?

as for administering the epi, your actions were appropriate.

please read the link i provided in post #13.

the nurses are playing dirty.

probably best that you move on.

leslie

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Specializes in Jack of all trades, and still learning.

So this man did not just have red mans syndrome but also other symptoms. You did right.

I hope you wrote everything down.

Re: lawyers. I really don't know how things work in the US. But thankfully we have a union, and I would have gone straight to them.

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Swelling of the eyes, erythema and pruritis to me(in a patient with a KNOWN adverse reaction in the near past to Vanco) would indicated both Benadryl AND SubQ Epi in the dose stated by the OP.

She was scrwed because the "aunt" got admin involved.

The doc was not very bright though IMHO.

You should get an attorney if this all happened as you stated.

Good luck

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Specializes in Cardiac, ER.

Ok,..I'm confused,...why is everyone so upset that you gave the epi? Was the pt injured? Are they just trying to say that there wasn't an order for the epi?

BTW I can't imagine working in a hospital that doesn't have standing orders, or protocols for emergencies ie allergic reaction. Do they honestly expect you to page a Dr and wait for a return call, write orders, send orders to pharm and wait for meds,...then take care of the emergency? What happens when someone codes? Do you just do CPR until a Dr can be contacted? Something smells fishy here!

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I think you did the right thing especially with the facial edema starting. I cannot understand the logic either of waiting until there was resp compromise.

Why did the doctor also not order Solu medrol?

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Specializes in Cardiac x3 years, PACU x1 year.

dirty, dirty stuff...

I personally would have refused to give the med if the pt had a previous allergic rxn. But sheesh, I am so sorry that they really ran you through the wringer! I would like to pow pow pow that Nurse Aunt for you. I hate dirty nurses...

Hugs!

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Thanks again for everyone's reply. Technically according to DON there was not a legal order for the epi. I thought that I had a verbal order. Everything happened as I stated. Pt. was fine after epi dose. DON says that I have no right to write my own orders for a high alert medication, although that was not my intention. I was supposed to call the ER dr, yes, and wait! BTW, I have never had a verbal or written warning before this incident. IN is an "employment at will" state. I may contact a nurse attorney for advice but don't know if I can have this taken off my record.

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The only thing I can think of regarding the "verbal order" is that you prescribed the dosage and not the physician, and with no protocols behind you, there's really no leg to stand on; it wasn't a complete order.

When a physician says "have this on hand" I always assume to have it readily available (ie., at the bedside so you don't have to wait to get it out of the pyxis or anything).

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