Created on October 13, 2023
In this module, you will learn the basics of Vancomycin medication administration.
Please review the entire module before taking the test
By the end of the module the reader will be able to...
- 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
+ Click here for a special caution.
Functional class: AntibioticChemical class: Tricyclic glycopeptide
Pharmacokinetics of vanco vary depending on route of drug.Absorption
- PO= poor
- IV=complete absorption
- The Liver
- PO: feces
- IV: kidneys
- 4-8 hours
+ Click for more info
Used to treat multiple bacterial infections
- Clostridioides difficile-associated diarrhea
- Gram-positive bacterial infections
+ What do you do with Red Man?yndrome?
Common Adverse Reactions
- Red-man Syndrome
- flushed/red skin
- fever and chills
- Peripheral edema
- Thrombophlebitis at IV site
Life-Threatening Adverse Effects
Call the Provider!
- Clostridioides difficile infection (CDAD)
How to administer the drug
- Verify Provider's Order
- Check allergy list
- Follow the Nine Rights of Medication Administration
- Educate the Patient
+ The 9 Rights
+ What to Educate
- 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
The Nurses' Role
Cultures/SensitivitiesWBC, UA, StoolSputum
I&OsBUN and Creatininehematuria/oliguria
Trough levelsTemperatureWBCs & Renal Labs
assess hearingCheck for s/s of Red Man Syndrome
Skin and Ears
Watery/Bloody Stoolabdominal painfever, pus, nausea, dehydration
- 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).
What if the Level is High?
Increased risk of nephrotoxicity (Kidney damage) especially if the patient is taking other antibiotics and medications that are nephrotoxic.
Increased risk for superinfections that are resistent to vancomycin such as VRE.
What if the Level is Low?
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
Know and be aware of the next due Trough Level
Collect the lab, no more than, 30 minutes prior to the scheduled Vancomycin Dose
Initiate Vancomycin dose when lab accepts the requisition
Check for trough levels & report to provider & Pharmacist(Follow their instructions)
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.
Now it is time to test your knowledge
Which of the following is a possible life-threatening Adverse Reaction?
Moderate Peipheral Edema
Trace rash on arms
Moderate nausea and fever
Which spectrum is Vancomycin designed to treat?
Gram + Bacterial Infections
Gram - Bacterial Infections
VRE & MRSA
You have a Trough-Level order due before the 1600 scheduled dose of Vancomycin. When can you draw the trough?
You checked a trough level and it is 23. What is your initial intervention inresponse?
Assess your Patient
Notify both the provider and the pharmacist
Stop the currently infusing Vancomycin
Which labs is NOT critical to check prior to Vancomycin administration?
Culture and Sensitivites
Platelets and INR
Creatinine and BUN
National Library of Medicine. (2023). Vancomycin. www.ncbi.nlm.nih.gov. https://www.ncbi.nlm.nih.gov/books/NBK459263/
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
Skidmore-Roth, L. (2023). Mosby’s Drug Guide for Nursing Students. Elsevier.
You have finished the ModuleYou may now take your test
What to Educate
- Teach patient about side effects to report
- ringing in ears
- 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.
Remember that the medication is harsh on the kidneys (nephrotoxic).
- I & Os (Intake and Output) should be monitored.
- Encourage fluid intake (as permitted).
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.
Labs and Vital Signs
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.
- Stop the infusion
- Assess the patient
- Notify the Provider
- Antihistamines may be ordered
Red Man Syndrome
Red Man syndrome is an older term, the newer term is Vancomycin flushing syndrome (VFS)
Do NOT forget to notify the provider
The Nine Rights
- Right Patient
- Right Drug
- Right Route
- Right Time
- Right Dose
- Right Documentaion
- Right Action
- Right Form
- Right Response
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.
Ears and Skin
- Hearing can also be affected.
If the patient is taking any of the following medications, it will increase their risk for both ototoxicity and nephrotoxicity.
- Zoledronic acid
- Certain chemotherapy medications
Even though Vancomycin is intended to treat infections, secondary infections are possible.
- Please monitor lab trends and patient condition changes, both good and bad.
- New onset sore throat, fever, diarrhea, and fatigue are concerning adverse signs
The following individuals are at higher risk for adverse effects. Please exercise caution.
- Pregnancy and Breastfeeding people
- Crosses the placenta barrier
- High risk of nephrotoxicity
- Compromised Kidney Function
Do NOT forget to check for allergies or sensitivities to Vancomycin
Be a nurse that promotes quality care.
Gram-positive bacterial infections
- Clostridioides difficile
Please remember that this is a nephrotoxic drug.
Please note that here at TMC the Lab Requisition is already scheduled 30 minutes prior to the relevant 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.
This state occurs when antibiotics lose their effectiveness. The bacteria become drug-resistant.
- This can occur when the medication dose is not strong enough
- A patient does not take the complete medication regimen.
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 antihistaminesThe RN's responsibility is to ensure that both the provider and the pharmacist are aware of the sensitivity.