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Discussion

vancomycin in snfs

Can anyone out there identify with this? Lab is never on time to draw peak and trough. Should vanco be held before trough level is known? Also I was reading that use of a vacutainer is not as safe to draw blood from a PICC line. Anyone have any thoughts on this?

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Yes, you should hold Vanco until the trough level is known, as those numbers are essential for the proper dosage to be calculated. I know LTC is notorious for late lab draws (and other less-than-optimal aspects of sub-acute care), but those peaks & troughs, plus daily weights, are necessary in order to give therapeutic doses.....otherwise, what's the point of giving it?

Also, to answer your PICC question: I personally have never, nor would I ever advise anyone to use a vacutainer to obtain blood through a PICC. The catheter itself is rather delicate, and too much pressure of any kind can easily fracture it. This is one task you really should take your time in performing, not only to avoid damage to the catheter but to prevent lysis of the blood cells. There are several different techniques, you have to experiment to find out which works best for you and the particular patient situation you're presented with. :)

I'm with the last post. The trough level is often the most important. How late are you talking about lab being? If it's hours, then the level won't be right anyway, sometimes better to get it on next dose.

Also agree with blood withdrawal not being with a vacutainer. We only use 10ml or larger syringes to avoid over-pressure on PICC. Vacutainer shouldn't be used for the same reason. Doesn't really take much longer to use syringe method and a lot less time than repairing or replacing a leaking or damaged PICC. Definitely takes less time than dealing with an embolus!

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I'm with the last post. The trough level is often the most important. How late are you talking about lab being? If it's hours, then the level won't be right anyway, sometimes better to get it on next dose.

Also agree with blood withdrawal not being with a vacutainer. We only use 10ml or larger syringes to avoid over-pressure on PICC. Vacutainer shouldn't be used for the same reason. Doesn't really take much longer to use syringe method and a lot less time than repairing or replacing a leaking or damaged PICC. Definitely takes less time than dealing with an embolus!

Thanks for confirming what I thought. I told a new nurse to hold the vanco until she knew the trough, she never got that info, shift changed and she didnt hang it. So she has been told she made an error! That you have to wait for the peak level.

while i agree with the logic of the those who say to wait for the trough, i don't think it is that clear-cut. yes, it is important to know what the peak and trough are for dosing and to make sure they are not getting nephrotoxic, but it is also important to have a consistent amount of vanc in the system to fight the infection. you are really waiting on the trough to be sure it is not at a toxic level, the dose wouldn't usually be adjusted that quickly. in acute care, i've always waited for the trough results, but i've given vanc in home health, where the trough may take days to come back. (sometimes the vanc therapy is over before the trough value comes back!) if your facility doesn't have a policy, i'd either check with the pharmacist who is adjusting the dosing or the md to see what they want you to do. (by the way, in vanc dosing, the trough is used to determine the interval -- q12 hrs, q24hrs, etc; while the peak is used to determine the amount -- 1 gm, 750mg, etc).

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