Vanco

START

In this module, you will learn the basics of Vancomycin medication administration.

Vancomycin Administration

Learning Objectives

Citations

Quiz

Monitoring

Administration

Drug Info

Please review the entire module before taking the test

The Contents

• Understand the drug class of Vancomycin
• Understand the potential adverse reactions to administration
• List safe practices for drug administration
• Understand how to collect accurate monitoring levels
• Provide effective patient teaching
• Recognize the potential side effects
• Summarize how to collect the Trough Levels

By the end of the module the reader will be able to...

Objectives

Vancomycin

Drug Info

Pharmacokinetics of vanco vary depending on route of drug.Absorption

• PO= poor
• IV=complete absorption

Metabolism:

• The Liver

Excretion:

• PO: feces
• IV: kidneys

Half-Life:

• 4-8 hours

Functional class: AntibioticChemical class: Tricyclic glycopeptide

Vancomycin

Drug Class

+ Click here for a special caution.

PO route:

• Clostridioides difficile-associated diarrhea

IV route:

• Gram-positive bacterial infections

Used to treat multiple bacterial infections

CLINICAL USES

Drug Class

+ Click for more info

• Ototoxicity
• Red-man Syndrome
• puritis
• flushed/red skin
• myalgia
• hypotension
• nausea
• tachycardia
• angioedema
• fever and chills
• Headache
• Backache
• Peripheral edema
• Thrombophlebitis at IV site

Common Adverse Reactions

Drug Class

+ What do you do with Red Man?yndrome?

GI:

• Nausea
• Clostridioides difficile infection (CDAD)

GU:

• Nephrotoxicity

HEMA:

• Leukopenia
• Eosinophilia
• Neutropenia

SYST:

• Anaphylaxis
• Superinfection

Call the Provider!

Life-Threatening Adverse Effects

Drug Class

How to administer the drug

IV ADMINISTRATION

+ info

• Verify Provider's Order

• Check allergy list

• Follow the Nine Rights of Medication Administration

• Educate the Patient

Pre-Administration

ADMINISTRATION

Pre-Administration

+ What to Educate

+ The 9 Rights

+ info

• Follow the Nine Rights of Medication Administration
• Know when the next Trough Level is due
• Consider running at a slower initial rate if...
• first vanco dose
• previous sensitivity/allergy

IV Administration

ADMINISTRATION

The Nurses' Role

Monitoring

CDAD

Watery/Bloody Stoolabdominal pain fever, pus, nausea, dehydration

Skin and Ears

assess hearingCheck for s/s of Red Man Syndrome

VS/Labs

Trough levelsTemperature WBCs & Renal Labs

Kidneys

I&OsBUN and Creatinine hematuria/oliguria

Infection

Cultures/SensitivitiesWBC, UA, Stool Sputum

Assessment

+ info

• Labs need to be collected 30 minutes before the scheduled vancomycin dose

• It CANNOT be collected earlier than this.

• Collecting the trough on time and maintaining an appropriate level of the medication, can prevent the development of vancomycin-resistent strains while balancing kidney function. (Rosini & Srivastava, 2013).

Trough Levels

ADMINISTRATION

What if the Level is Low?

Increased risk for superinfections that are resistent to vancomycin such as VRE.

Increased risk of nephrotoxicity (Kidney damage) especially if the patient is taking other antibiotics and medications that are nephrotoxic.

What if the Level is High?

Trough Levels

+ ino

If the patient is actively infusing a dose of Vancomycin during an RN hand-off report, at bedside check...

• The medication bag and label.
• The rate of medication infusion
• Assess the skin for any signs of sensitivity
• Ask for the trough lab requisition
• Review the patients I&Os
• Output vs Input
• Stool status

Hand-Off Report

ADMINISTRATION

Step 4

Check for trough levels & report to provider & Pharmacist(Follow their instructions)

Step 3

Initiate Vancomycin dose when results are released OR within the dosing window

Collect the lab, no more than, 30 minutes prior to the scheduled Vancomycin Dose

Know and be aware of the next due Trough Level

Step 2

Step 1

Trough Levels

Every nurse

The nurse is ultimately responsible for ensuring that the medication is given safely and that all scheduled vancomycin troughs are collected in a timely manner.

START

Now it is time to test your knowledge

QUIZ

Moderate nausea and fever

Trace rash on arms

Moderate Peipheral Edema

Which of the following is a possible life-threatening Adverse Reaction?

QUESTION 1/5

QUIZ

RIGHT!

QUIZ

NEXT

VRE & MRSA

Gram - Bacterial Infections

Gram + Bacterial Infections

Which spectrum is Vancomycin designed to treat?

QUESTION 2/5

QUIZ

RIGHT!

QUIZ

NEXT

1500

1600

1530

You have a Trough-Level order due before the 1600 scheduled dose of Vancomycin. When can you draw the trough?

QUESTION 3/5

QUIZ

RIGHT!

QUIZ

NEXT

Stop the currently infusing Vancomycin

Notify both the provider and the pharmacist

Assess your Patient

You checked a trough level and it is 23. What is your initial intervention inresponse?

QUESTION 4/5

QUIZ

RIGHT!

QUIZ

NEXT

Creatinine and BUN

Platelets and INR

Culture and Sensitivites

Which labs is NOT critical to check prior to Vancomycin administration?

QUESTION 5/5

QUIZ

RIGHT!

QUIZ

NEXT

Skidmore-Roth, L. (2023). Mosby’s Drug Guide for Nursing Students. Elsevier.

Rosini, J. M., & Srivastava, N. (2013). Understanding vancomycin levels. Nursing, 43(11), 66–67). Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1097/01.nurse.0000435209.34142.0e

National Library of Medicine. (2023). Vancomycin. www.ncbi.nlm.nih.gov. https://www.ncbi.nlm.nih.gov/books/NBK459263/

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References

You have finished the ModuleYou may now take your test

Congratulations!

• Teach patient about side effects to report
• ringing in ears
• diarrhea
• chills, nausea, IV site pain, etc.
• Ensure patient understands that regular lab draws will be needed and why.
• Teach the patient the reason for the medication.
• PO meds: make sure the patient understands to take ALL the prescribed doses. If doses are missed the chance of superinfections increases.

What to Educate

The basics...

The Kidneys

Remember that the medication is harsh on the kidneys (nephrotoxic).

• I & Os (Intake and Output) should be monitored.
• Encourage fluid intake (as permitted).

Check kidney function lab tests before administering the next dose.

INCORRECT

Labs and Vital Signs

Remember that Vanomycin can have adverse side effects that can be reflected in the labs. Trough Levels are very important. Their therapeutic range is between 10-20 and the exact target goal depends on the indication.

CDAD

CDAD is short for Clostridium Difficile Associated Diarrhea. This is a potential adverse infection from IV vancomycin use. a side effect of IV vanco is C-diff. The treatment for c-diff is PO vancomycin. Please educate your patient and assess for stool changes.

Red Man syndrome is an older term, the newer term is Vancomycin flushing syndrome (VFS)

Red Man Syndrome

1. Stop the infusion
2. Assess the patient
3. Notify the Provider
4. Antihistamines may be ordered

NOTE: The infusion may be restarted at a slower rate, if the provider approves.

1. Right Patient
2. Right Drug
3. Right Route
4. Right Time
5. Right Dose
6. Right Documentaion
7. Right Action
8. Right Form
9. Right Response

The Nine Rights

• Hearing can also be affected.

Ears and Skin

Some people are sensitive to Vancomycin which can manifest on the skin.Check for rash, itch, swelling, and other integumentary changes. Prevention: Do NOT infuse the medication faster than prescribed. Some sensitive patients may need it to be infuse at a slower rate to prevent Red-Man syndrome.

• Acyclovir
• Tacrolimus
• Zoledronic acid
• Certain chemotherapy medications

Ototoxicity

If the patient is taking any of the following medications, it will increase their risk for both ototoxicity and nephrotoxicity.

• Please monitor lab trends and patient condition changes, both good and bad.
• New onset sore throat, fever, diarrhea, and fatigue are concerning adverse signs

Infection

Even though Vancomycin is intended to treat infections, secondary infections are possible.

INCORRECT

INCORRECT

INCORRECT

Ideally, we won't hang the vancomycin dose until the trough levels are released. Per TMC policy, the lab should release vancomycin trough levels within 1 hour. However, this may not always occur. If results are not released within the medication dosing window, administer the medication.

The Dosing Window

INCORRECT

INCORRECT

INCORRECT

INCORRECT

INCORRECT

Do NOT forget to check for allergies or sensitivities to Vancomycin

Caution

The following individuals are at higher risk for adverse effects. Please exercise caution.

• Pregnancy and Breastfeeding people
• Crosses the placenta barrier
• Neonates
• High risk of nephrotoxicity
• Compromised Kidney Function

• Staphylococcus
• Clostridioides difficile
• Endocarditis:
• Diphtheroid,
• Enterococcal
• Staphylococcal
• Streptococcal

Gram-positive bacterial infections

Please note that here at TMC the Lab Requisition is already scheduled 30 minutes prior to the applicable scheduled dose of vancomycin. This means that if you have the fourth dose of Vancomycin scheduled for 1300. The lab requisition will be timed for 1230, and the lab should NOT be collected prior to this time.

Lab Requisitions

INCORRECT

• This can occur when the medication dose is not strong enough
• A patient does not take the complete medication regimen.

Example: VRE

Superinfections

This state occurs when antibiotics lose their effectiveness. The bacteria become drug-resistant.

For select patients with mild allergies or sensitivities, the provider may determine that the benefits outweigh the side effects. In these cases, the medication may be ordered at a slower rate and/or premedicated with antihistamines The RN's responsibility is to ensure that both the provider and the pharmacist are aware of the sensitivity.

Allergy/Sensitivity