[birdsnbees]

I've been a labor nurse for a long time now and worked in a few ob units, and up until now I've seen Pitocin run up to 20 mu/min, and occasionally with a doctors order, up to 25 mu/min. I've recently started working in a unit where they routinly titrate up to 50 and 60 and even higher during a routine induction of labor. I've looked on line trying to find safe titration levels but so far I have not found info in this. Has anyone ever run Pitocin at these doses?

[epiphany]

On our floor, I've never seen it titrated much beyond 20 mu/min, and even that's rare. (And I thought our floor was bad). There is research out there - though I don't have it in front of me that says that titration above a minimal amount (around 6-10, I think) does not improve outcome.

[RNfromMS]

Our unit uses the 20u of pitocin in 1000cc of D5LR and can titrate up to 32mu per protocol; can go up to 36mu with a doctor order.

[Mrs.S]

our standing orders state titrate up to 28 mu/min but per MD order I've seen it as high as 42. we recently had some of our RNs attend a conference where they discussed what a previous poster mentioned, that increasing Pit past 6 or so mu/min is ineffective. the information they shared was interesting.

[ragingmomster]

we routinely get orders to titrate up to 36-40 mu/min.

but i find that if we get up that high, it just isn't going to work for some reason anyway, and it is time to call a section.

[birdsnbees]

Thanks for your comments, I really appreciate it. So 40 is as high as anyone has mentioned here so far.
It seems like these people do often deliver.....the ones at 50+ mu, but I think if the pit was off, they would probably still deliver. Just my opinion.
Another thing is though, it seems like I see more decels, and I'm wondering if it's related to the high rates of pit. I would think receptors would be saturated long before 50 mu's is reached, yet these women often do look hyperstimulated to me, and though the decels are variable in nature, there are often a lot of them, and they are deep. This is just not ok with me. There is nothing in our orders or in the protocol that gives a top number of pitocin titration. I'm feeling uncomfortable with all this.

[MemphisOBRNC]

We mix 20 Units in 1,000 ml, start at 2 mU and increase by 1-2 mU q 15 -30 minutes to a max of 30 mU/min.

[htrn]

I can't say off the top of my head how high we have run pit, but we have run it over 50mu. We pit VBACs and do it without IUPCs as we have one doc that will NEVER put in an IUPC, regardless - don't ask unless you want a new oraface! We don't have a top limit in our p&p and none of us are comfortable with the really high rates, esp with no IUPC.

I'm just glad I'm not the only one that deals with this. There have been arguments made that we as RNs can be held liable for even increasing the pitocin - have been told at some conferences to make the MD increase the rate on the pump.

[epiphany]

I am very uncomfortable with the abuse of Pitocin to force women into labor, and this is one of the reasons I'm considering quiting L&D.

As of now, while I have my mother on pit, I watch her tracing closely and constantly palpate her. At the sign of an unhappy baby, I get very nervous.

Do you have a guideline for hyperstimulation or hypertonus in your P&P? Our guideline for hyperstimulus is ctx >q2 mins, relaxation <30 secs, and duration >90-120 secs. We don't have a guideline for hypertonus, but AWHONN does. I try to use these guidelines to make my case - but it doesn't make me very popular.

[mitchsmom]

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