Test ID: VANCR
Vancomycin, Random, Serum
Secondary ID 
A test code used for billing and in test definitions created prior to November 2011
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
Monitoring adequacy of drug concentration during vancomycin
therapy
This unit code is used whenever a specimen is submitted
or collected without collection timing information. Random levels
may be ordered when attempting to determine when to dose
vancomycin in patients with renal impairment or those undergoing
dialysis.
Method Name A short description of the method used to perform the test
Immunoassay
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Container/Tube: Red top
Specimen Volume: 1 mL
Collection Instructions:
1. Spin down within 2 hours of draw.
2. Serum for a peak level should be drawn 1 hour after completion of dose (order VANPK/80141 Vancomycin, Peak, Serum). Serum for a trough level should be drawn no more than 30 minutes prior to next dose (order VANCT/81592 Vancomycin, Trough, Serum).
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | Mild OK; Gross reject |
| Lipemia | Mild OK; Gross reject |
| Icterus | Mild OK; Gross reject |
| Other | Serum gel tube |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Serum Red | Frozen | 14 days |
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Vancomycin is an antibiotic used to treat infections caused by gram-
positive organisms that are resistant to beta-lactam antibiotics, such
as methicillin-resistant staphylococci (MRSA), Staphylococcus
viridans group, penicillin/cephalosporin-resistant Streptococcus
pneumoniae, and penicillin/ampicillin-resistant Enterococcus
species. The oral formulation, which is not absorbed, is used in the
treatment of pseudomembranous colitis caused by Clostridium difficile.
Vancomycin is also used when patients are intolerant or allergic to beta
lactams.
Vancomycin has been associated with nephrotoxicity and ototoxicity,
although it appears that many of these reports reflected impurities in
early formulations. Monitoring of vancomycin-related nephrotoxicity
is recommended only for patients with reduced renal function, those
receiving aggressive or prolonged vancomycin regimens, or those at
high risk including patients comedicated with other nephrotoxic agents.
Trough concentrations are recommended for therapeutic monitoring of
vancomycin, preferably acquired at steady state (just before fourth
dose). To avoid development of resistance, vancomycin trough levels
should remain >10 mcg/mL. Complicated infections require higher target
levels, typically 15 to 20 mcg/mL. Peak concentrations do not correlate
well to efficacy or nephrotoxicity, but may be useful for
pharmacokinetic studies or for select patients.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
VANCOMYCIN, TROUGH
Therapeutic concentration: 10.0-20.0 mcg/mL
Complicated infections: 15.0-20.0 mcg/mL
VANCOMYCIN, PEAK
Therapeutic concentration: 25.0-50.0 mcg/mL
Interpretation Provides information to assist in interpretation of the test results
Trough levels correlate better with efficacy than peak levels, with
target trough levels of 10 mcg/mL to 20 mcg/mL, depending on the
type of infection.
Peak levels are not recommended for monitoring, except in
select circumstances such as when performing pharmacokinetic
analyses (eg, area under the curve [AUC] determinations).
Typical peak levels are between 25 to 50 mcg/mL.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Rybak M, Lomaestro B, Rotschafer JC, et al: Therapeutic drug
monitoring of vancomycin in adult patients: A consensus review
of the American Society of Health-System Pharmacists, the
Infectious Diseases Society of America, and the Society of
Infectious Diseases Pharmacists. Am J Health Syst Pharm
2009;66:82-98
2. Estes L, Wilson J: Mayo Guide to Antimicrobial Therapy,
Mayo Clinic, 2005-2008
Method Description Describes how the test is performed and provides a method-specific reference
Enzyme-multiplied immunoassay technique (EMIT) performed using
the Olympus analyzer. EMIT offers an alternative to the traditional
spectroscopic and chromatographic method for quantitating blood
concentrations of drugs. The technique for drugs is based upon an
enzymatic assay for glucose-6-phosphate dehydrogenase, using
spectral properties at 340 nm, in which the reduction of nicotinamide
adenine dinucleotide (NAD) substrate is monitored. The basis of the
drug detection technique is an immunological reaction between the
drug and a specific antibody. The reagent contains the enzyme
(glucose-6-phosphate dehydrogenase) to which the drug is
Covalently bound and an antibody specific to the drug. The antibody
binds most of the drug-bound enzyme, rendering the enzyme inactive.
This results in a baseline enzymatic activity. In the presence of free
drug, antibody equilibrates between free drug and enzyme-bound
drug leaving some of the drug-bound enzyme uncomplexed and able
to catalyze the reaction. If more free drug is introduced, either as
standard or sample, then competition for the antibody takes place
between the drug in the sample and the drug attached to the enzyme.
This results in more drug-bound enzyme being left uncomplexed and
able to catalyze the enzyme reaction at a greater rate as compared
to the baseline activity. The observed enzyme activity increases
with the amount of total free drug in the sample. (Moyer TP:
Therapeutic drug monitoring. In Tietz Textbook of Clinical Chemistry,
4th edition. Edited by CA Burtis, ER Ashwood. Philadelphia, WB
Saunders Company, 2005, pp 1237-1285)
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Monday through Sunday; Varies
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
80202
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| 81749 | Vancomycin, Random, S | 20578-1 |
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