Therapeutic antibiotic serum concentrations by two blood collection methods within the pediatric patient: A comparative effectiveness trial

Abstract

Repeated venipunctures and fingersticks to confirm serum drug concentrations cause pain and dissatisfaction for pediatric patients and their families. In many organizations, the standard of care to obtain therapeutic serum drug concentrations by peripheral venipuncture or capillary fingerstick, even when the patient has an existing peripheral intravenous catheter (PIV) or central venous catheter (CVC). The primary objective of this study was to assess agreement between serum tobramycin/vancomycin concentrations collected from a CVC or PIV, versus venipuncture or fingerstick. Among hospitalized pediatric patients (age 3 months to 22 years), 36 paired blood samples were collected. Serum trough vancomycin and random tobramycin concentrations were compared between peripheral intravenous or CVC samples, and venipuncture or fingerstick samples within the same patient. A strict sampling protocol for obtaining the samples was followed, that included collection of the CVC/PIV sample before the venipuncture or fingerstick, less than 2 min between collections of samples from the different sites, and a strict volume-based flush and waste protocol. Concordant correlation coefficients demonstrated substantial agreement between CVC/PIV and venipuncture/fingerstick concentrations for vancomycin (n = 17) and tobramycin (n = 19) (Rc = 0.982 for both). Bland-Altman analyses demonstrated good overall between-method agreement within subjects and minimal bias. Consequently, using a lumen volume-based flush and waste protocol, children with indwelling catheters may not require additional venipunctures and/or fingersticks for confirmation of drug concentrations while hospitalized, improving the quality of care and patient satisfaction.

Aminoglycoside dosing and monitoring for Pseudomonas aeruginosa during acute pulmonary exacerbations in cystic fibrosis

“…A waste sample was then collected before the therapeutic sample and the volume of the waste sample was also determined by the catheter type and size. The Rc value, the concordance correlation coefficient which reflects both accuracy and precision, for both tobramycin and vancomycin was 0.982, demonstrating good agreement between the two sample collection methods 41 . Based on these findings, none of the 36 samples collected from either CVC/PIV versus peripheral venipuncture/fingerstick would have required a clinically significant dose adjustment.…”

Recent Advances in Therapeutic Drug Monitoring of Voriconazole, Mycophenolic Acid, and Vancomycin: A Literature Review of Pediatric Studies

“…The venipuncture or capillary fingerstick might be considered painful and stressful. Lichlitter et al [146] conducted a study in which the blood samples were collected by existing central venous catheter (CVC) and peripheral intravenous catheter (PIV). The measurements were conducted for VAN and tobramycin in pediatric patients.…”

A comparison of aminoglycoside antibiotic serum concentrations collected by peripheral veins and peripherally inserted central catheters in adults with cystic fibrosis

“…4,5 Recent studies have demonstrated substantial agreement in intravenous anti-pseudomonal antibiotic serum levels when collected by PV vs PICC in pediatric PwCF, suggesting that TDM by PICC may be acceptable. [6][7][8] Serum levels obtained by PV can cause pain, and patient dissatisfaction in both children and adults. [9][10][11][12] In addition, 2).…”

“…However, there are concerns that intravenous antipseudomonal antibiotic serum levels may be falsely elevated when collected directly through a PICC 4,5 . Recent studies have demonstrated substantial agreement in intravenous anti‐pseudomonal antibiotic serum levels when collected by PV vs PICC in pediatric PwCF, suggesting that TDM by PICC may be acceptable 6–8 . Serum levels obtained by PV can cause pain, and patient dissatisfaction in both children and adults 9–12 .…”