|Laboratory:||Clinical Biochemistry (AUTOMATED)|
VANCOMYCIN - (P) or (S)
Test Code: VANC
1. Test indications- Management of vancomycin dosing
No Peak reference ranges available. Trough serum vancomycin concentrations are the most accurate and practical method for monitoring efficacy.
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 serum vancomycin concentrations are the most accurate and practical method for monitoring efficacy. 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.
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.
Plasma: 2.0 mL
Pediatric Plasma: 0.2 mL
Stability 2 weeks refrigerated, 1 year frozen
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)
No Peak reference ranges available.
Trough serum vancomycin concentrations are the most accurate and practical method for monitoring efficacy
Trough level monitoring reference interval: 10 - 20 mg/L
Toxic trough level > 28 mg/L
Target serum/plasma trough of 15–20 mg/L are recommended for severe documented MRSA infections to improve penetration, increase the probability of optimal target plasma level, improve clinical outcomes in aggressive management of complicated infections, and for prosthetic valve endocarditis cause by Staphylococci.
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.
24/7 Routine / OR / PAC / STAT