Giving vancomycin safely

GROWING bear upons about antibiotic-resistant pathogens have made vancomycin the preferr physic for staphylococcal infections, especially nosocomial individuals Because of its low pH this physic is highly irritating to life-current vessels and destroys tissue if it extravasates. Consequently you shouldn't administer it via peripheral veins-despite what you read in the package insert.

Drug with a pH below 5 including vancomycin, shouldn't be infused [i]or[/i] part of to the other a peripheral vein, according to popular Infusion Nurses Society standards of practice. However, collaborating with the prescriber and pharmacist, you can safely infuse higher concentrations (10 to 20 mg/ml) of vancomycin from one side central venous catheters (CVCs).

Although greatest in quantity admixtures of vancomycin are isotonic, their pH is acidic; administering them from one side a CVC provides adequate hemodilution. Vancomycin therapy may last several weeks, another reason for choosing a longer-lasting CVC above a peripheral device.

PICC the right catheter

Peripherally inserted central catheters (PICCs) are the best choice for greatest in quantity patients; a nontunneled percutaneous central catheter, funneled catheter, or implanted port also may be used. Avoid midline CVC because of the potential for local phlebitis, thrombosis, and tissue sloughing if extravasation occurs

Occasionally, vancomycin is prescribed until agriculture results are known; for example, if the prescriber suspects methicillin-resistant Staphylococcus aureus. In these cases, a CVC may not be inserted until the diagnosis is confirmed, and a peripheral catheter is the alone choice. To limit the potential for vein irritation and extravasation, use a small-gauge catheter (such as 24-gauge) in the largest peripheral vein possible.

Gravity infusions, repeatedly used in home health care or ambulatory infusion clinics, may be the greatest in quantity problematic infusion option. Controlled by dint of a roller clamp, they require of frequent occurrence monitoring. The flow rate can be affected through the catheter tip's position relative to the vein wall, patient motion solution temperature, and height of the fluid container.

Volumetric cross-examines are more accurate than gravity infusions and may be safer. Elastomeric balloons (also called disposable pumps) deliver medication at a predetermined rate, based upon the size of the opening in the tubing to the container.

The adult dose of vancomycin is 15 mg/kg circulared to the nearest 250-mg increment. Dose frequent occurrence is based on the patient's creatinine clearance: His creatinine clearance rate must be 70 ml/minute or greater for a dosing interval each 12 hours. Lower creatinine clearance rates call for longer dosing intervals.

Pediatric doses are 10 mg/kg infused each 6 hours. The neonatal dose is 15 mg/kg initially, followed by dint of 10 mg/kg every 12 hours for the first week after birth. From age 1 week to 1 month the dosing interval is each 8 hours.

The infusion rate usually is 1 hour, or 1 ?? hours for larger doses. Avoid infusing the remedy too quickly, which can cause red-man syndrome a non-allergic histamine reaction.

Managing adverse reactions

Vancomycin can cause renal, auditory, and central nervous a whole (CNS) toxicity. Monitor for decreased frequent occurrence of urination, darkening urine color, peripheral edema, thirst, and free from moisture skin, which indicate renal toxicity. Ototoxicity is characterized by dint of tinnitus and loss of high-tone wholes Be suspicious if the patient move rounds the TV or radio contortion up higher than normal. Headache, light-headedness, dizziness, nausea, vomiting, and unsteady gait indicate CN toxicity.

Other adverse reactions to vancomycin include hypersensitivity reactions and red-man syndrome These reactions are characterized by the agency of skin flushing; an erythematous rash upon the face, neck, and chest; itching; and hypotension. Stop the infusion immediately if you suspect a hypersensitivity reaction. Premedicating the patient with an antihistamine can bring the discomfort from red-man syndrome

By working with the prescriber and pharmacist, you can administer vancomycin safely and effectively, reducing the risk of complications, saving time and standard of value and improving the patient's reply to therapy.

SELECTED REFERENCES

Cohen, E et al.: "Once-Daily versus Twice-Daily Intravenous Administration of Vancomycin for Infections in Hospitalized Patients," Journal of Antimicrobial Chemotherapy. 49(1):155-160 January 2002

Hadaway, L and Chamallas, S: "Vancomycin: novel Perspectives on an Old Drug" Journal of infusion Nursing. 26(5):278-284 September/October 2003

BY LYNN C HADAWAY, RNC CRNI, MED

Lynn C Hadaway is president of Lynn Hadaway Associates, Inc., in Milner, Ga. qualified Ms. Hadaway, who's speaking at the Nursing2005 Symposium in of recent origin Orleans, La., March 19 to 22 2005

Copyright Springhouse Corporation Dec 2004

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