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Discussion

Vancomycin rate question

At he hospital I work at the pharmacy prepares out vanc and its always like 2.75 or 3 grams per 500ml and says to run 250/hr. But everyone always says run it slower so I set it at 125-150/hr. My question is is that an acceptable rate and also should it be y'd in above or below the pump because I have seen it both ways. I've been attaching above the pump and setting it up as secondary with ns as primary at KVO.

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    • Featured Replies

    What Members Are Saying
    Members are discussing vancomycin infusion rates, optimal dosing for obese or septic patients, and the safety of 3-gram doses. Debates continue on infusion methods, pump configurations, and the appropriate duration for administration. The necessity of consulting pharmacists and the implications of asking multiple nurses the same question remain unresolved.

    Infusing Vanco too fast is dangerous clinically, not just because it is a vesicant. Micromedex (our pharm reference) recommends infusing no faster that 10mg/min. Infusing faster can potentially lead to hypotension and red man syndrome. Also with higher doses you need to monitor for ototoxicity.

    At my facility we infuse >1gm at 90min and 1-2gm at 2 hrs. As far as the pump, the vanco should be running as the primary through the pump. You should not y site Vanco below the pump, doing so the vaco could dump in. If you y site above the pump it would be delivered at whatever rate the primary is running. So if you had the NS set to 100ml/hr the Vanco would be going in at that rate. Better to use two pumps in my opinion or set vanco as the primary and the fluids as the secondary to infuse after the antibiotic completes.

    I have never seen a dose of Vanco 3 grams ordered. Only 1gram, 1.5 or 2. Are you sure that is your Vanco dose? Seems higher than any of the recommendations for treatment of anything unless you are dealing with very obese patients.

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    Infusing Vanco too fast is dangerous clinically, not just because it is a vesicant. Micromedex (our pharm reference) recommends infusing no faster that 10mg/min. Infusing faster can potentially lead to hypotension and red man syndrome. Also with higher doses you need to monitor for ototoxicity.

    At my facility we infuse >1gm at 90min and 1-2gm at 2 hrs. As far as the pump, the vanco should be running as the primary through the pump. You should not y site Vanco below the pump, doing so the vaco could dump in. If you y site above the pump it would be delivered at whatever rate the primary is running. So if you had the NS set to 100ml/hr the Vanco would be going in at that rate. Better to use two pumps in my opinion or set vanco as the primary and the fluids as the secondary to infuse after the antibiotic completes.

    I have never seen a dose of Vanco 3 grams ordered. Only 1gram, 1.5 or 2. Are you sure that is your Vanco dose? Seems higher than any of the recommendations for treatment of anything unless you are dealing with very obese patients.

    Do you use Alaris pumps at your institution? I don't hang ABX as a primary, always as a secondary because I always have something running and I usually have a free KVO line running, too. That way, once the ABX is complete the primary will kick in and resume (either fluids or KVO). I've seen >2g doses of vancomycin for patients that are very obese. For example, a 2.5g loading dose and then 1.5g maintenance dosing pending the results of the vanco trough.

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    • Expert
    Infusing Vanco too fast is dangerous clinically, not just because it is a vesicant. Micromedex (our pharm reference) recommends infusing no faster that 10mg/min. Infusing faster can potentially lead to hypotension and red man syndrome. Also with higher doses you need to monitor for ototoxicity.

    At my facility we infuse >1gm at 90min and 1-2gm at 2 hrs. As far as the pump, the vanco should be running as the primary through the pump. You should not y site Vanco below the pump, doing so the vaco could dump in. If you y site above the pump it would be delivered at whatever rate the primary is running. So if you had the NS set to 100ml/hr the Vanco would be going in at that rate. Better to use two pumps in my opinion or set vanco as the primary and the fluids as the secondary to infuse after the antibiotic completes.

    I have never seen a dose of Vanco 3 grams ordered. Only 1gram, 1.5 or 2. Are you sure that is your Vanco dose? Seems higher than any of the recommendations for treatment of anything unless you are dealing with very obese patients.

    I know I specifically stated the Vanco would be on it's own pump. Some patients cannot have their primary stopped for various reasons.. Vanco can be given at 3gms however monitoring for toxic effects is imperative

    [h=3]Dosing Considerations[/h] General dosing recommendation: 2 g/day IV divided q6-12hr; may be increased on basis of body weight or to achieve higher trough values; increased toxicity at dosage >4 g/day

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    • Expert
    I hate to hijack the thread, but I've never given 3 grams of Vanco at one time. I've given 2 grams, but rarely.

    We have to mix our own on nights, and we use a ratio similar to what others have posted. Is 3 grams usual?

    Sometimes you do the same thing the same way every day, and you get locked into routine, without hearing about how other nurses do things.

    I have seen it in patients who are very large and in the presence of sepsis in cardiac patients with a mediastinal infection
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    One addition to the thoughts, if you and the pharmacy work out running the vanco slower/faster, please make sure the timing for a vanco trough lab is adjusted accordingly.

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    your questions are great, that's good you have a lot of questions, it keeps patients safe! That's how we learn :)

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    First off, I know this was in 2014 but I came across this and read the replies and WOW. Vanc should be ran over 90 minutes, no less than 60 min in a large vessel. That’s standard. 
     

    Secondly, SierraBravo- seriously? No. Ask everyone and anyone.

     

    If people get offended because you asked someone else they are too worried about their ego and not about the patients best interests. Always follow your gut and ask until you get the answer you feel best with.
     

    Many new nurses on my cardiac ICU unit ask several people, and NOBODY takes offense to it because everyone understands that we all do things differently and you have to find your own way.
     

    The more you ask the better because it shows you want to learn. As for only asking the charge nurse etc sometimes the charge nurse doesn’t know or won’t help. 
     

    Ask. Always just ask. I’m sorry people were so dismissive of you here. I’m sure you’re a great seasoned nurse now!

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