A client is scheduled to receive a dose of vancomycin IV. The nurse notes the client's creatinine clearance (CrCl) is 25 mL/min. Which action should the nurse take?
- AAdminister the vancomycin at a slower infusion rate.
- BAdminister the vancomycin as prescribed.
- CHold the vancomycin and notify the provider.
- DCheck the client's peak and trough levels before administration.
Show answer & explanationAnswer & explanation
Correct answer: C. Hold the vancomycin and notify the provider.
Vancomycin is primarily renally excreted and is nephrotoxic and ototoxic. A creatinine clearance of 25 mL/min indicates significant renal impairment (normal is >90 mL/min). Administering the usual dose of vancomycin to a client with impaired renal function can lead to accumulation and increased risk of toxicity. The nurse must hold the medication and notify the provider for a potential dose adjustment or alternative antibiotic.
Why the other options are wrong
- A. Slowing the infusion rate helps prevent 'Red Man Syndrome' but does not address potential drug accumulation due to impaired excretion.
- B. Administering the vancomycin without adjustment could lead to toxicity due to renal impairment.
- D. While peak and trough levels are important for vancomycin, checking them before administration in a client with significantly impaired renal function does not address the immediate risk of toxicity from the current dose; the provider needs to adjust the dose first.
Vancomycin and Renal Impairment
Vancomycin is an antibiotic with narrow therapeutic index that is primarily eliminated by the kidneys. In clients with renal impairment, vancomycin accumulation can occur, significantly increasing the risk of nephrotoxicity (kidney damage) and ototoxicity (hearing damage). Dosage adjustments are essential based on renal function.
- Vancomycin is renally excreted.
- Nephrotoxic and ototoxic.
- Impaired renal function increases toxicity risk.
- Creatinine clearance indicates renal function.
Memory trick: Vancomycin's kidneys clear, if they're weak, toxicity is near!