How do you document Pitocin on the I&O?
- 0I have just completed my 4th week of orientation on L&D and I ran into something that I am confused about. My preceptor does not include Pitocin used for induction/augmentation of labor on the I&O record since it is difficult to determine how many mLs the pt got if we are constantly increasing or decreasing the Pit q 15-30 min. Instead she simply documents the rate of Pitocin on the flow sheet where we documents our ongoing assessments q 15-30 min.
However, the other day we took over for another nurse who had a pt receiving Pitocin for augmentation of labor and we noticed that she was including the rate of Pit in her I&O record.
So I was just wondering what you do at your facility and if you had any advice for me about how to keep track of Pitocin for the I&O record??
I want to be a great L&D nurse and I want to ensure that I always have complete charting.
Thanks in advance.
- 1Sep 3, '12 by Ashley, PICU RNDo your pumps keep a record of the total volume infused? Every electronic pump I've used keeps track of the total volume until you reset it. Seems like you should just be able to look at this setting on the pump each hour and it will tell you how much volume the patient got.
I don't work in L&D but we do document all our drips on the I&O- even if we are titrating frequently.
- 0Thanks Ashley, that sounds like a great suggestion. We have two different IV pumps on our units, Alaris and Imed. I am more familiar with the Alaris pump and I'm pretty sure you can see the volume infused... but I'm not sure if we can with the blue Imed pump. I'll take a look at this with my preceptor when I go into work tomorrow.
- 0Sep 3, '12 by FyreflieI guess it depends on how you're mixing and running your oxytocin!! My first unit, we mixed 10 units in 1000 ml and started at 2.5 mu/min = 15 ml/hr and so by the time we made it to max pit (40 mu--250 ml/hr approx!) we were running large volumes of fluid/hr. In that case, I documented by clearing the pump volumes--not necessarily every hour, as the volumes started out smaller, but every four to eight depending on what was going on. Exceptions to that were people with fluid restrictions (ie hypertension issues)--they got totaled every hour in labour from the beginning.
On my current unit we mix 20 units in 1000ml and start at 1mu/min = 3ml/hr. I do not bother with those volumes until we hit 20 ml/hr or so and if I do totals its usually every 8-12 hours. Once a shift basically. If they're hypertensive I still do hourly because that's part of our order set on mag etc. I have rarely had a pt go through one bag of pit in an entire labour, and we only go up to 20mu max on my unit now so 60 ml/hr.
It really depends on your comfort level and assessment!! I know nurses who measure every void starting on admission to a labour room whether it's ordered or not--some even dip every single one!! I start measuring only if there's a reason--someone who has had a lot of IV fluid, for example, to make sure they're diuresing appropriately. But a woman who has nothing on board for pain and is drinking, has no IV and is moving around? I just ask her if she feels empty when she's done, or if she's able to void normally.
It's always good to document appropriately but I personally don't think I would worry about being so detailed--although I probably was when I first started we do enough nitpicky work and triple charting as it is, right?
- 0Thank you Fyreflie, your post was very helpful. We use 20 units pitocin in 1000 ml and start at 2 mu/min which is 6 ml/hr and we increase by 2 mu/min q 15-30 depending on the order. I always document the rate of the pitocin with my ongoing assessments and I document every time I change the rate. My preceptor says that should be enough... but I guess I wanted to make sure whether that was correct.
I guess because I am new I want to be thorough.Last edit by Kayla.J.RN on Sep 3, '12 : Reason: typo
- 0Sep 8, '12 by jodyangelThis is a good question. I just finished orientation at a new facility and they do all online charting. So they chart hourly I&O online, and the pit is making my head hurt lol. Only because every nurse that oriented me told me a differant way of knowing how many mls of pit were going in each hour. And yes with all the titration I found it Very confusing and honestly totally inacurate.
In my former job we did the paper intake and output..so you would just clear your pump at the end of your shift and that was that. Simple.
I will try the clear your pump volume infused method..see if that is clearer..
- 0Sep 11, '12 by guambaAt my facility we use Alaris pumps and you absolutely should document the I&O of pitocin. It's important to know how much you're pumping into your patient and whether or not they're clearing it. You don't necessarily have to do hourly I&O documentation unless they're high risk I.e. in controlled hypertensive or pre-ecmalptic, kidney disease etc. I would bet all pumps have a volume infused option.
Also, no matter how often you're titrating the mu/min (and you should be documenting this on the MAR) the ml/hr is what you're documenting on the I&O flowsheet.