Evidence-Based practice re: Pitocin Inductions

[HazeKomp]

Help...

I need suggested documentation of studies documenting how/why to run pitocin for induction.

why?

our docs want us to increase pit q15"...

our AWHONN stuff says q 30...so my boss says...

The docs have statistics and studies showing efficacy of "high dose" pitocin, up q15-20, decreasing c/s rate and faster labors....

I need references to show why pit should not be adjusted more often than q30"....IF there are support documents for this.

Please let me know if anyone has any good studies that would be good for us to review!! Our "High Reliability Unit" meets again in 3 weeks to share data and finalize our protocols.

Thanks!

Haze

[LDRNMOMMY, BSN, RN]

We also use 30 Units in 500ml normal saline. We have low dose protocol start at 1 milliunit per minute and increase q30 by 2 milliunits decrease 1-2 milliunits q 30 minutes once adequate ctx pattern reached. Max of 20 milliunits.

High dose protocol: start at 6 milliunits per minute, increase by 6 milliunits q 15 min until max of 42 milliunits. Decrease by 6 milliunits per minute once adequate ctx pattern reached.

We also have mds that order to start with 2 milliunits and increase by 2 milliunits q15 min max of 32.

[NurseNora, BSN, RN]

I am surprised at how different dosing is from place to place (I just finished posting a thread about the same thing when I found this thread). One thing we sometimes do at my hospital if the mom is on fluid restriction is put 20 mu/500 ml. You just have to pay attention because the increments are 1.5 ml/hr - so you have to watch your math!

That's why my hospital moved to 30 Units in 500cc. This dose does go well for those who need fluid restriction, and you always have the same concentration to work with. Calculation errors increase when you have to work with different concentrations. 30Units in 500cc is 1mU/min=1mL/hr. You don't have to worry about cheat sheets, or the 6X table or if you're using the right conversion factor.

[NurseNora, BSN, RN]

Our normal procedure is to start at 2 and increase 2-4 q 15. I don't think docs read AWOHNN.

The docs don't read nursing literature. If you want to "prove" anything to a doctor, you have to use literature produced by physicians. ACOG has guidelines that the docs follow. There is a very wide range of protocols sanctioned by ACOG (their version of AWHONN, which used to be NAACOG, the Nurses Association of the Americian College of OB & GYN). So if you want to change anyone's practice, you have to reference ACOG guidelines or articles in the Green Journal.

[q12RN]

we use 10 units in 1000cc D5LR