Gentamicin Peak and Trough
When are Gent peaks and troughs drawn for 24 hour dosing?
1 hour after the start of the 3rd dose of Gent for the Peak.
30 minutes before the 3rd dose of Gent for the trough.
Example: 3rd dose of (24 hour dosed) Gent due at 1500. Trough at 1430 and Peak at 1600.
Should a glucose be done on all new admissions?
Yes, all new admits should have a glucose drawn upon admission
Standard dosing for all blood products (PRBC, Platelets, Cryoprecipitate, FFP)
15ml/kg
When are Gent peak and troughs drawn for 48 hour dosing?
Trough before the 2nd dose and peak 1 hour after the start of the 2nd dose.
ie Scheduled dose at 1200, trough at 1130 and peak at 1300
When a glucose is low and a bolus is needed, what is the intervention?
2 ml/kg D10W bolus over 5 minutes and recheck the glucose in 30 minutes
How fast do you run PRBC?
Standard is over 4 hours. May run faster if ordered.
Do you need to hold the Gent dose until the trough is back?
Yes, once the gent trough results are back, call the provider to get the ok to give the Gent dose. This could delay the slightly and you will have to adjust the peak time if it is to be drawn after that same dose.
Why is it important to recheck glucoses as ordered?
To prevent and appropriately treat hypoglycemia and hyperglycemia. These checks cannot be timed with other blood draws and are important to be done as ordered.
How fast do you run platelets, cryo and FFP
Why is the peak monitored?
Why is the trough monitored?
Peak is the peak drug level (30 minutes after the end of the gent administration). Goal Range 5-10 mg/L
Trough is the lowest level of gent in the infant's system prior to the next dose. Monitoring for clearance of the medicaiton. Goal Range <0.2 mg/L If levels are too high we will adjust the interval and recheck levels in 12 hours.
Insulin administration, tubing prep
Have IV tubing put together and waiting for insulin to arrive, so it can be hung ASAP. Once Insulin has arrived, you must spike the tubing and let it sit in the tubing for 20 minutes before hanging. This is done due to the insulin adsorption to the plastic tubing and decreasing the concentration of insulin delivered to the patient.
Can you run blood products through a PICC?
No, need to use a PIV, UAC or UVC. May give in pushes through a UAC or UVC. Need to divide dose by 5 and give a slow push once and hour.
Complications of Gentamicin
Nephrotoxicity and hearing loss
Montior infant's urine output closely
Infants receiving at least a week of antibiotics will follow up outpatient with Audiology at 9 months
Insulin has to be ran through it's own line
Label the line and do not use it for other medications or IVF's. You will give a bolus of Insulin, if you do this. Change the tubing if you are done with insulin. Do not use that port, label it do not use after infusion is done.
When is minimal donor used?
Extreme prematurity or will require multiple transfusions.