Vanco Vera — Vancomycin: Slow the Infusion, Watch the Trough, Protect the Kidneys and Ears
His face and neck turned red twenty minutes into the infusion — the drug is not the problem, the speed is
Twenty minutes into a vancomycin infusion a client's face and neck flush deep red. Vera slows the pump before she does anything else.
Vera is the nurse who never rushes vancomycin. Infusion-related flushing of the face, neck and upper chest happens when vancomycin is given too fast; the fix is to stop or slow the infusion, give it over at least 60 minutes, and expect an antihistamine — this is a rate reaction, not a true allergy. Vancomycin is also nephrotoxic and ototoxic: monitor BUN, creatinine, urine output and any new ringing in the ears or hearing loss. Trough levels are drawn 30 minutes BEFORE the next dose, and a peak (when ordered) after the infusion finishes.
Read Vanco Vera's full story →The story arc
The setup
A client with a serious MRSA infection starts IV vancomycin, and the pharmacy asks for a level before the fourth dose.
The turn
A busy night shift speeds the infusion to free up the pump.
The crisis
The client's face, neck and chest turn red and itchy, and his blood pressure drifts down.
The save
Vera slows the rate, treats the reaction, and starts tracking creatinine, urine output and one new complaint: ringing in his ears.
NCLEX study section — Vancomycin: Slow the Infusion, Watch the Trough, Protect the Kidneys and Ears
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Pharmacology
Take this chapter into practice questions on the same topic.