Vancomycin, Trough Level

Vancomycin, Trough Level

Epic Mnemonic
Sunquest Mnemonic

LAB39
VANT

Category

Chemistry

Methodology

KIMS Assay

Test Performance Schedule

Sunday - Saturday

Result Availability

Within 24 hours

Container

Preferred: Gold top (SST) tube, Red top (serum) tube, or Green top (lithium heparin) tube 
Alt: Lavender top (EDTA) tube

Volume

Pref. Vol.: 1.0 mL serum or plasma
Min. Vol.: 0.5 mL serum or plasma

Collection Instructions

• Collection Timing: Draw trough sample immediately before next dose

• Routine venipuncture

• Immediately after collection, gently invert tube 5-10 times

• Clot 30 minutes

• Promptly centrifuge 10 minutes

• If no gel barrier is present immediately transfer serum or plasma to a plastic tube and refrigerate

• Properly centrifuged gel barrier tube does not require transfer of serum or plasma to separate tube

Transportation Instructions

Refrigerated

Stability

• Room Temperature: 2 days
• Refrigerated: 5 days

Causes for Rejection

• Mistimed specimen collection

Remarks

Patient Preparation:
• Administer IV infusions over a 60 minute time period
• Document exact start and end times for infusions on requisition

CPT Codes

80202

Effective/Revised

03/29/2017

Vancomycin is an antibiotic which is used for the treatment of infections caused by Gram-positive organisms, primarily methicillin resistant Staphylococcus aureus (MRSA), coagulase-negative Staphylococci, Streptococci or Enterococci, particularly in patients allergic to β-lactams.

Common side effects include, amongst others, the following: (a) red man syndrome, ahistamine-mediated flushing during or immediately following infusion, (b) nephrotoxicity, and (c) ototoxicity; the latter two adverse events are dose/level dependent.

In former years the monitoring of peak and trough levels has been recommended. Meanwhile the relevance of monitoring peak concentrations is questioned by some clinicians due to limited clinical data.

Monitoring of trough serum or plasma levels is necessary to ascertain clinical efficacy and to limit potentially dose-dependent serious side effects, e.g. ototoxicity and nephrotoxicity. The potential for the latter two serious adverse events has established therapeutic drug monitoring (TDM) of vancomycin as the standard of care. Trough levels are typically obtained before or after the 4th dose of the drug and then monitored at least once weekly.