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Laboratory:

Clinical Biochemistry (AUTOMATED)

Test Name:

VANCOMYCIN - (P) or (S)

Test Code: VANC

Clinical Information:

1. Test indications- Management of vancomycin dosing

No Peak reference ranges available.

Clinical judgment should guide the frequency of trough monitoring when the target trough is 15 – 20 mg/L.

Frequent monitoring (more than one trough before the fourth dose) for short course or lower intensity dosing (to attain target trough concentrations below 15 mg/L) is not recommended.

All patients on prolonged courses of vancomycin (exceeding three to five days) should have at least one steady-state trough concentration obtained no earlier than at steady state following the fourth dose), and then repeated as deemed clinically appropriate.

The definition of vancomycin-induced nephrotoxicity is a reminder that monitoring creatinine is a part of TDM for vancomycin

2. Patient Preparation Instructions- Trough Levels: collect blood for trough concentration within 45 minutes prior to the next dose

Peak Levels (if required for pharmacokinetic profiling): collect blood 1 - 2 hours after the end of the Vancomycin infusion.

Collection Devices:

Preferred Device:	1 - Li Heparin, NO GEL 4.0 mL Tube(s) - Full Tube Collection Li Heparin, NO GEL 4.0 mL Tube(s) - Full Tube Collection Manufacturer: BD (Becton Dickinson) Catalogue #: 367884
Alternate Device:	1 - Microtainer(s) - Li Heparin NO GEL (0.4 mL) to fill line Microtainer(s) - Li Heparin NO GEL (0.4 mL) to fill line Manufacturer: Becton Dickinson & Company Catalogue #: 365965 - pediatric

NOTE: Vitros requirement is serum collected without gel. Heparin plasma is not acceptable. EDTA plasma may be used for hemodialysis patient samples & immediate on-site testing during off-hour callback situations only.

Specimen Required:

Plasma: 2.0 mL

Pediatric Plasma: 0.2 mL

Stability 2 weeks refrigerated, 1 year frozen

Referral:

Full size tube collection: 2 mL plasma
Microtainer collection: 0.2 mL plasma
Samples must be transferred to an aliquot tube and stored frozen if analysis will not be complete within 48 hours (#110-10-05 Serum / Plasma Separation Procedure & Transport)

Requisition:

_SH Biochemistry Hematology Requisition (R250-10-92)

_SH Hospital Biochemistry Hematology Non Winnipeg Brandon (R250-10-91)

_SH Winnipeg Brandon Biochemistry Hematology Requisition (R250-10-94)

_SH Winnipeg Brandon Hospital Biochemistry Hematology Requisition (R250-10-93)

Reference Values:

No Peak reference ranges available.

Trough level monitoring reference interval: 10 - 20 mg/L
Toxic trough level > 28 mg/L

It is highly recommended to consult a clinical pharmacist for result interpretation. Optimal trough vancomycin levels are determined by a number of clinical factors in additon to being dependent on the type of microbial infection.

Availability:

24/7 Routine / OR / PAC / STAT