Our pharmacist has approached us about delivering Vancomyin in a 60ml syringe, if the patientÂ has central venous access. Â Is this practice accetable?
What will be the rate of infusion and how will this be controlled? This may be acceptable if you have a central venous catheter and the rate is controlled. The current concentration recommendations were established when the drug first came out in the 1950's, when CVCs were not used. And the manufacturers have not incentive to do the required studies to get the FDA to allow changes. Please read more details in:
1. Hadaway L, Chamallas S. Vancomycin: New perspectives on an old drug. Journal of Infusion Nursing. 2003;26(5):278-284.
Lynn Hadaway, M.Ed., NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Office Phone 770-358-7861
According to the pharmacist, the Vancomycin is mixed 1 GM in 60ml NS with the infusion rate of 1 hour by central venous access. This is being done in the home care setting and the reason is because of how the syringe pump is programmed. My concern is the potential for "red man" sydrome. And, then what happens? The home care RN is no longer at the bedside. Does the patient know what to do? etc. Thanks for the article information. So...is this a safe and acceptable practice?
Ann Zonderman, BSN, JD, CRNI, LHRM
A common infusion for home care is use of syringe pumps and elastomeric pumps which work like a balloon - deflating as the medication is infused over a specific time. Many of these use 100 ml for dilution. (there are other sizes) It is the time for infusion that is also important.
I was prescribed Vanco 1 Gm and it was diluted in such a device to deliver over an hour... but for me that was too fast. I got a redman syndrome reaction. Subsequent infusions were slowed by me...
I have trained many patients to administer and self monitor such infusions. There is always a back up nurse to call and patients are instructed what to do in emergencies.
Ann Zonderman, BSN, JD, CRNI