Vancomycin levels immediately before hanging new bag

[powertoold]

Hey,

Do any of your facilities draw vancomycin levels immediately before hanging the new dose? If so, what sort of drawbacks have you noticed?

We're trying to figure out a better way of taking the levels because a lot of them (~40%) are > 1hr before the dose.

I can see just a few drawbacks of taking the level immediately before:

1) The nurse may take it after hanging the bag (but I don't think it will happen very often)

2) The level may come back high but the dose will already be given (I haven't seen any cases where it would have been really important to hold the dose)

Thanks!

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[WVUPharm2007]

30 minutes before is the standard. The nurses need to comply with this. Its not really something YOU need to work around. They need to get it into their heads that it is paramount that they do this prior to the 4th dose.

If they do screw up, you'll just have to try to extrapolate with the data you have and get a real trough in the mean time next dose. Don't worry too much about overdosage...worry about getting that trough over 10 and in the sweet spot of 10-15 or 15-20 depending on diagnosis.

 

[TemSirolimus]

30 minutes before is the standard. The nurses need to comply with this. Its not really something YOU need to work around. They need to get it into their heads that it is paramount that they do this prior to the 4th dose.

If they do screw up, you'll just have to try to extrapolate with the data you have and get a real trough in the mean time next dose. Don't worry too much about overdosage...worry about getting that trough over 10 and in the sweet spot of 10-15 or 15-20 depending on diagnosis.

Extrapolating is not too accurate as you do not have a peak value. You would have to assume a peak so as to calculate the k and thus half-life.

It should be hammered quite emphatically into the nurses heads the need for accurate draws.

 

[powertoold]

30 minutes before is the standard. The nurses need to comply with this. Its not really something YOU need to work around. They need to get it into their heads that it is paramount that they do this prior to the 4th dose.

I believe the "30 minutes before" direction doesn't mean "exactly 30 minutes before;" it actually means "within 30 minutes before the next dose." It doesn't matter if you took it 1 or 29 minutes before.

The whole point is to allow the nurse time to take the level sometime "just" before the next dose, rather than forget about it and take it after. I believe when vanco wasn't used as much, it was important to use the "30 minutes before" direction so it was clear what you wanted.

Obviously, we can tell the nurses that it's important to take these levels on time, but we have a lot of traveling / training nurses here, and there are thousands of them in total. It's not easy to change their ways or workload 😛 Plus, a lot of doctors write "take level 30 minutes before 4th dose," and it gets taken 1:30 before. It's not like the directions are unclear.

 

[WVUPharm2007]

Extrapolating is not too accurate as you do not have a peak value.

Yes...but some data is better than no data. If the nurse takes it 1.5 hours early and the Tr is 10.4...you at least know you are likely underdosing.

 

[WVUPharm2007]

Obviously, we can tell the nurses that it's important to take these levels on time, but we have a lot of traveling / training nurses here, and there are thousands of them in total. It's not easy to change their ways or workload 😛 Plus, a lot of doctors write "take level 30 minutes before 4th dose," and it gets taken 1:30 before. It's not like the directions are unclear.

I worked at the most dysfunctional hospital in the United States. And we still had it beaten into the nurses heads that this was VERY important and must NEVER be screwed up. Not doing it correctly meant being written up.

 

[Its Z]

Hey,

Do any of your facilities draw vancomycin levels immediately before hanging the new dose? If so, what sort of drawbacks have you noticed?

We're trying to figure out a better way of taking the levels because a lot of them (~40%) are > 1hr before the dose.

I can see just a few drawbacks of taking the level immediately before:

1) The nurse may take it after hanging the bag (but I don't think it will happen very often)

2) The level may come back high but the dose will already be given (I haven't seen any cases where it would have been really important to hold the dose)

Thanks!

Take a random level yo.

You know how to calculate extrapolated Cmax based on Vd, dose, and/or previous level if there's one. Then plug it into

Ke = Ln(Cmax/Cmin)/T2-T1

T1/2 = 0.693/Ke

Now, you know the clearance and can estimate the trough. So no need to draw trough within an hour before the next level.