Talking with our pharmacy, there is no guidelines that he has ever heard of
that state you must put Vanc of any dose up to 1.5gm in 500ml to meet
guidelines. Standard dosing is usually 5mg/ml because you don't always know
if you patient has a peripheral line or gotten their central line yet. For
home based patients they all have a central line and our pharmacy goes up to
10mg/ml based on the literature out there. For inpatient use they use the
up to 1.5 gm in 250ml because with overfill and fluid of the vanc it is well
over 300ml meeting the 5mg/ml guideline standard. They do this until they
have confirmation the patient has a central line. They also adjust the
amounts of fluid for various doses.
Pharmacy also questioned that your facility may have a instituitional policy
and that is why they are now insisting on this extreme amount of fluid.
Check that out. My question to them is if Vanc is being ordered q 8hrs as
it is sometimes that is 1500 of fluid and some of our home based patients
could not tolerate that type of extra overload. I would recommend asking to
see the guidelines they are going by and I will attempt to get the
literature from my pharmacist to support the 10mg/ml to share with the
group.
Our pharmacy set up at our facility has been showcased for it's set up. We
have a dedicated Home based pharmacist monday -friday. The CCU/ICU has 1
pharmacist assigned to that unit. The other acute care floors have no more
than 2 floors assigned to one pharmacist. We regularly on a daily basis
interact with our pharmacist and they are quite a visible force in our
facility.
We are very lucky. This is why I would even put this information out. They
are on the cutting edge of some of our pharmacy protocols. I hope this
helps.
Betsy Harmon RN CRNI
Vascular Access Team
Critical Care Unit
Alaska Native Medical Center
Anchorage, Alaska
[EMAIL PROTECTED]
----- Original Message -----
From: <[EMAIL PROTECTED]>
To: "Riley, Deb" <[EMAIL PROTECTED]>
Cc: <[EMAIL PROTECTED]>
Sent: Wednesday, April 26, 2006 2:49 PM
Subject: Re: vanc infusion volumes
We put all Vanco doses in 250ml and haven't had any problems. We always
use a central line and usual
infusion time is 60 minutes unless the patient has rate-related reaction.
Do you know to which guidelines
the pharmacist is referring?
----- Original Message -----
From: "Riley, Deb" <[EMAIL PROTECTED]>
Date: Wednesday, April 26, 2006 2:18 pm
Subject: vanc infusion volumes
Can homecare members give me some feedback on how your vanc is
suppliedfor home infusion. We used to have any vanc doses up to
1.5gm put in
250ml diluent to infuse over 60-90 minutes. Anything over 1.5gm
went in
500ml of diluent to infuse over 2-2 1/2hr. The pharmacist is now
telling us they have to put 1.5gm in 500ml in order to meet
guidelines.Is everyone else doing the same?
Deb Riley RN CRNI
Infusion Supervisor
Summa's Homecare
Akron, Ohio
