Lab Information Manual

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.

For patients with central line and on antibiotic lock, drug levels MUST be drawn from a peripheral site to avoid contamination of blood sample leading to falsely elevated drug levels. Please refer to policy regarding collection of blood samples for antibiotic levels by Kidney Health Manitoba.

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)

Testing Laboratory (MB): Health Sciences Centre, St. Boniface, Westman, Seven Oaks, Grace, Bethesda, Boundary Trails, Dauphin, Portage, The Pas and Thompson

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