Vancomycin Infusion Rate During Hemodialysis

[JamesGarland]

Please help me with this situation.

I work at a franchise Hemodialysis center and we have a large turnover of staff as well as many technicians. Because of this, I think some of the nursing information is inadequate.

Frequently we administer Vancomycin during the last portion of the therapy.

The instructions on the prescription state to run this 1 gram of Vancomycin over one hour. I have some senior nursing staff pressuring me to run this in 45 minutes or less. When I disagree with them, they become angry, defensive and belittle me. They tell me that because the Vancomycin is being run through either a central line or a fistula, we aren't worried about "Burning the vessel" like you would with a peripheral line.

I was always taught that it also had to do with the activation of histamine causing "Red Man Syndrome".

We have a local infusion pharmacy here and they stated that we absolutely should not run the Vancomycin in less than 60 minutes.

Help me please!

[JKL33]

Let them be upset all they want. You have to make decisions based upon accepted knowledge, not peer pressure.

Yes, vanco is a vesicant but that is not the sole issue of concern.

Your pharmacy has already confirmed your understanding about the correct rate.

From the package insert/drug info retained by the FDA:

Quote

Vancomycin should be administered over a period of not less than 60 minutes to avoid rapid-infusion-related reactions.

Source: https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/050671s024lbl.pdf

Also:

Quote

RMS most frequently occurs with IV vancomycin but may rarely occur from oral or intraperitoneal vancomycin.[4][5][6] It usually is related to a rapid infusion rate of vancomycin (1 gram in less than 1 hour). Current treatment recommendations are to administer vancomycin at a rate no faster than 1 gram/hour or 10 mg/min.

Source: https://www.ncbi.nlm.nih.gov/books/NBK482506/

When they pressure you tell them that you can't find anything to substantiate their idea and you are going to administer the medication according to the published instructions.

[canoehead, BSN, RN]

You have to follow the pharmacy recommendations, no matter what another coworker says.

[HandsOffMySteth]

Just my 2 cents, if you don't follow the proper instructions and something goes wrong , it will your license on the line. Nothing will happen to them.

["nursy", RN]

Show them the documentation. I've had patients develop red man syndrome. It ain't fun, and then you have to stop the infusion completely, which will certainly prolong the process.