Vancomycin
| PATIENT INFO |
| Patient Name: |
| Medical Record #: |
| BD: / / Sex: F M |
| PHYSICIAN INFO |
| Physician Name : |
| Address: |
| Ph: ( ) - Fax: ( ) - |
| Additional Report to: |
| Ph: ( ) - Fax: ( ) - |
| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. Vancomycin | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
VANCO
Test Workstation :
MACH3
Specimen Type:
Blood
Tube Type:
Green top ( lithium heparin ) tube
Collection Volume:
500 uL microtainer; 1.5 mL macrotainer
Minimum Volume:
500 uL microtainer; 1.5 mL macrotainer
Preferred Volume:
500 uL microtainer; 1.5 mL macrotainer
Storage:
Shipping- Send Refrigerated; Storage-Room Temp 48hrs: 2 days; Refrigerated: 2 weeks; Frozen: 1 year
Availability:
24 hours/day, 7 days/week
Methodology:
Kinetic, KIMS
Special Instructions:
For therapeutic monitoring, draw peak levels 30 minutes after the completion of a 60 minute IV infusion and trough levels immediately prior to the next dose. Please indicate whether the specimen is a peak, tough, or random level.
Lab/Phone:
330-746-9623
TAT:
1 hour
Additional Info:
Reference Range Therapeutic:
Randon= 5-50 ug/mLPeak = 20-40 ug/mL
Trough = 7-15 ug/mL
CPT Code:
80202
Synonyms:
Vancocin
