anyone use prepidil?????

[babyktchr, BSN, RN]

I work with a practice that uses prepidil a lot for ripening and induction ( I know, I know) Our current policy states, based on drug manufacturers information, that pitocin cannot be started for 6-12 hours after last insertion. I have done a medline search and have come up with a few articles that support the drug co. recommendations. One of the docs is FURIOUS and we constantly battle with him about this time issue. In his eyes this is SILLINESS and does not allow for correct management of individual patients. Basically the literature that I have found opts to wait this time period because of the high instances of hyperstim with prepidil. Ok. But sometimes you have NO contractions. Then what?? Because of the written policy, we have had to abide by the written laws of the land, and hear his complaining. I have begged him to argue his point to the powers that be, and not with the nursing staff.

Anyone using prepidil out there, and if so...what is your policy on starting pitocin??

[MemphisOBRNC, BSN, RN]

We haven't used Prepidil in a LONG time. He should switch to Cervidil, then he wouldn't have to wait for hours for the Pit. to be started. It's much easier to insert in that it doesn't require the use of a speculum. It can be sort of tricky to get it in the posterior fornix without it coming out of place when you take your fingers out. We nurses put it in but couldn't do the Prepidil.

[feebebe23]

We have 1 doc that uses prepidil.....he places it himself at 0700. And yes I am sure he puts it INTO the cervix as opposed to behind it. 9 times out of 10.....they deliver by 1200. Our policy states we can start pit 4 hours after prepidil. That being said.....we also have a policy that states an MD can write an order in violation of the hospital policy as long as he informs the patient (and gets consent from the patient) that "this is in violation of hospital policy"

example: our policy states that we only use 25mcg of cytotec....but 1 doc loves 50mcg cytotec. So he goes to the patient and tells her "the hospital recommends 25 but I want to use 50 on you blah blah blah....risks/benefits....blah blah blah....pt says "what ever you say doc....and thats it.

I have also been told that the MD can do what ever they want so in your situation.....you hang and prime the pit....MD walks over presses the start button.....and you just manage the patient....he can come over and turn it up when he wants.

I don't know if this helps....but this are my experiences:)

[HazeKomp, BSN, RN]

We haven't used Prepidil in a LONG time. He should switch to Cervidil, then he wouldn't have to wait for hours for the Pit. to be started. It's much easier to insert in that it doesn't require the use of a speculum. It can be sort of tricky to get it in the posterior fornix without it coming out of place when you take your fingers out. We nurses put it in but couldn't do the Prepidil.

We quit using Prepidil in Las Vegas when the manufacturer changed the package insert to read it must be placed by a physcian! Prior to that, nurses placed prepidil per MD orders. I actually prefer it to cervidil as it seemed to work faster, didn't seem to cause the lady partsl swelling and tenderness that we see with Cervidil, and it doesn't tie up a labor bed for 12 hours! But, since nurses can place Cervidil and cannot place Prepidil and our doctors are too busy/lazy/?? to come to the bedside any more than necessary, Cervidil is the cervical ripening agent of choice in 'Vegas!