Download Section: 2-1

Medications – Vancomycin Administration
Strength of Evidence Level: 3
PURPOSE:
To provide accurate and safe administration of
intravenous vancomycin.
CONSIDERATIONS:
1. Vancomycin is used to treat serious or severe
infections when other antibiotics are ineffective or
contraindicated, including those caused by
susceptible organisms, particularly gram positive
organisms including Staphylococci, Methicillinresistant Staph aureus, Staph epidermidis and
diptheroid organisms; Group A β-hemolytic strep,
Streptococcus pneumoniae, Enterococci,
Corynbacterium and Clostridium.
2. Vancomycin is administered intravenously for
treatment of infections. Recommended dosing is as
follows:
a. Adults: 1 g IV every 12 hours.
b. Children: 10 mg/kg IV every 6 hours.
c. Infants: Initial dose 15 mg IV followed by 10
mg/kg IV every 12 hours.
3 Patient-specific dosing is adjusted based on weight,
serum levels, clearance of the drug, and the volume
of distribution of administered drug.
4. Vancomycin is primarily excreted via the renal
pathway. Patients with renal impairment will likely
need their dose and dose interval adjusted to
reduce toxic effects of the drug.
5. Adverse Effects:
a. Renal: Geriatric and neonatal patients are at a
greater risk of nephrotoxicity; increased serum
Cr and BUN, decreased Cr Clearance and
(rare) interstitial nephritis.
b. Ototoxicity: Damage to eighth cranial nerve.
Hearing loss and permanent deafness has
occurred. Rarely, vertigo, dizziness and tinnitus.
c. Redman’s Syndrome: Presenting with sudden
decrease in blood pressure and accompanied
by flushing and/or maculopapular rash or
erythematous rash on the face, neck, chest and
upper extremities. Redman’s syndrome is
usually associated with too rapid of infusion of
medication and extending the infusion period
may eliminate or reduce the extent of the
reaction. Wheezing, dyspnea, angio-edema,
urticaria and pruritis may also occur.
d. Hematological: Leukopenia, eosinophilia and
rarely, thrombocytopenia.
e. Miscellaneous: Anaphylaxis, drug fever, chills,
nausea, phlebitis.
6. Vancomycin should not be given IM due to the risk
of tissue necrosis. Administer via the IV route with
particular attention to preventing infiltration or
extravasation of drug into the surrounding tissue.
7. Vancomycin doses should be infused over at least
60 minutes to decrease the likelihood of adverse
effects.
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8.
Concomitant use of other ototoxic and/or
nephrotoxic drugs should be avoided due to the risk
of additive toxicity.
9. Concomitant administration of Vancomycin with
anesthetic agents in children has been associated
with erythema and histamine-like flushing.
10. Vancomycin trough levels, BUN and creatinine
should be obtained periodically as necessary.
11. Levels should not be drawn from the same vascular
access device through which the dose was
administered without flushing with a volume
sufficient to clear the drug from the line.
EQUIPMENT:
None
PROCEDURE:
1. Verify orders with physician:
a. Route (IV only), dose and duration of therapy.
b. Recommend laboratory orders as necessary.
2. Review patient’s medical record and prior history.
3. Adhere to Standard Precautions.
4. Identify patient and explain procedure.
5. Initiate therapy using appropriate vascular access
device and administer drug solution over at least 60
minutes. Utilize appropriate control device based on
dosage.
6. During therapy, closely monitor the patient for the
following problems and contact the physician
promptly for:
a. Increases in serum Cr and/or BUN, and
increases in Vancomycin trough levels.
b. Any reported signs of ototoxicity.
c. Any signs of hypersensitivity.
7. Teach patient to check access site daily for phlebitis
and irritation and to report any pain at infusion site
to avoid extravasation.
8. Review and discuss actions and side effects with
the patient and/or caregiver and document on the
patient visit record.
9. Dispose of supplies properly.
AFTER CARE:
1. Document in patient’s medical record:
a. Procedure and observations.
b. Patient’s response to procedure.
c. Instructions given to patient and/or caregiver.
d. Communication with physician.