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Therapeutic Drug Monitoring (TDM) Collection Guidelines for Legacy Randall Children’s Hospital If drawing the blood sample outside of the parameters ordered, call the pharmacy or the physician before drawing the sample. Drug level results must be obtained before administering the next scheduled dose. Drug level labs may need to be ordered STAT for dose or interval adjustment. Notify pharmacy/physician of out-of-range drug level results. If minimum risk to the patient, please draw the preferred volume of whole blood. If retesting is necessary, a sample of minimum volume will not provide enough blood. When possible, avoid drawing the minimum volume of whole blood. DRUG INFUSION TIME WHEN TO DRAW LEVEL SPECIMEN TUBE/ AMOUNT Collect: 1 plain red top tube (1 microtainer is OK if filled to fill line) Carbamazepine -- Just before the next dose Preferred Vol: 2.5 mL whole blood Minimum Vol: 0.6 mL whole blood Collect: 1 lavender top tube (2 microtainers is OK if filled to fill line) Cyclosporine - IV/PO 2-4 hours Just before the next dose Preferred Vol: 2.5 mL whole blood Minimum Vol: 1.2 mL whole blood Collect: 1 plain red top tube (1 microtainer is OK if filled to fill line) Digoxin - IV/PO Fosphenytoin (measure Phenytoin levels) - IV 5-10 minutes Just before the next dose Peak 2 hours after the end of infusion Preferred Vol: 2.5 mL whole blood Minimum Vol: 0.6 mL whole blood Collect: 1 plain red top tube (1 microtainer is OK if filled to fill line) 3 mg/kg/minute Preferred Vol: 2.5 mL whole blood Minimum Vol: 0.6 mL whole blood Trough just before the next dose IV NICU: Trough within 30 minutes before administration of the dose and then the peak 30 minutes after the end of the 30 minute infusion of the same dose. Gentamicin 30-60 minutes Traditional dosing: Peak 30 minutes after the end of the 30-minute infusion Trough within 30 minutes before the next dose Once daily dosing: Random level 8-12 hours after the dose Collect: 1 plain red, gold, mint green or lavender top tube (1 microtainer is OK if filled to fill line) Preferred Vol: 2.5 mL whole blood Minimum Vol: 0.6 mL whole blood IM Peak 1-2 hours after injection Trough within 30 minutes before the next dose Print new copies from Intranet Last Approved Date: 2/6/2017 Legacy Laboratory Client Services (503) 413-1234 Toll Free (877) 270-5566 Page 1 of 2 Therapeutic Drug Monitoring (TDM) Collection Guidelines for Legacy Randall Children’s Hospital DRUG Phenobarbital INFUSION TIME 1 mg/kg/minute WHEN TO DRAW LEVEL SPECIMEN TUBE/ AMOUNT Collect: 1 plain red, gold or mint green top tube (1 microtainer is OK if filled to fill line) Just before the next dose Preferred Vol: 2.5 mL whole blood Minimum Vol: 0.6 mL whole blood Collect: 1 plain red top tube (1 microtainer is OK if filled to fill line) Phenytoin - PO Thiocyanate (Nitroprusside infusion) -- Trough just before the next dose Preferred Vol: 2.5 mL whole blood Minimum Vol: 0.6 mL whole blood Collect: 2 plain red or mint green top tubes Infusion Nitroprusside continuous infusion Preferred Vol: 7.5 mL whole blood Minimum Vol: 5.0 mL whole blood IV NICU: Trough within 30 minutes before administration of the dose and then the peak 30 minutes after the end of the 30 minute infusion of the same dose. Tobramycin 30-60 minutes Traditional dosing: Peak 30 minutes after the end of the 30-minute infusion Trough within 30 minutes before the next dose Collect: 1 plain red, gold, mint green or lavender top tube (1 microtainer is OK if filled to fill line) Preferred Vol: 2.5 mL whole blood Minimum Vol: 0.6 mL whole blood Once daily dosing: Random level 8-12 hours after the dose IM Peak 1-2 hours after injection Trough within 30 minutes before the next dose Valproic Acid – IV/PO Vancomycin 60 minutes 60-120 minutes Collect: 1 plain red, gold, mint green or lavender top tube (1 microtainer is OK if filled to fill line) Trough just before the next dose Trough within 30 minutes of the next dose Preferred Vol: 2.5 mL whole blood Minimum Vol: 0.6 mL whole blood Collect: 1 plain red, gold or mint green top tube (1 microtainer is OK if filled to fill line) Preferred Vol: 2.5 mL whole blood Minimum Vol: 0.6 mL whole blood Print new copies from Intranet Last Approved Date: 2/6/2017 Legacy Laboratory Client Services (503) 413-1234 Toll Free (877) 270-5566 Page 2 of 2