Once again, as a newer nurse, I'm here with a question about managing a patient on Pitocin. Feedback would be appreciated.
My patient was a Primip, who SROM'd , having UC's every 5 minutes, but not feeling them. I get orders for Pitocin. Throughout the night, she has a weird UC pattern, with contractions that are palpating moderately strong and she is getting increasingly uncomfortable, and that pick up with the TOCO from 1-3 minutes apart mostly. She'd have 10 minute periods where the UC's are every minute, with little time between them, so I kept the Pitocin farely low, the max I got to was 10mu/min. At the end of my shift she is checked by the resident and is only 1cm/50/-2.
The one coming nurse I gave report to talked about "Pit-ing through the dysfunctional pattern". Did I do the right thing by being liberal with the pit and how can one justify in the charting going up on the Pitocin when she is seemingly practically hyperstiming? thoughts??
Oct 30, '07
You can never get in trouble if you follow your policy on pitocin. Ours is 3 contx in 10 minutes for a goal. When you have hyperstim, the fetus is in jeopardy and can decompensate quickly and then YOU are in trouble. Follow policy and get your C/S chart ready as that is where most of these are headed.
Oct 31, '07
The very tricky thing about a seemingly "dysfunctional" pattern with u/cs every 1-3 minutes is that sometimes there is coupling or trebling and increasing the pitocin will break that pattern. Once you break that pattern you will see that the u/cs are truly 4 minutes apart but with coupling noted. I think following your policies and procedures is the only way to go ( and will support you in court!) but sometimes going up just by one milliunit and watching for a few minutes, you will see a change. It is tricky and I usually run it by my shift lead if I'm not sure....it's the only way you will learn! GOOD LUCK
Nov 5, '07
I don't believe in "pitting through a dysfunctional pattern" although a lot of providers encourage it, does your facility have an algorithm for hyperstimulation? Ours is just in the process of developing one that really does not allow you to go up on pit with >6 contractions in 10 minutes unless they are palpating mild, and even then the rate and number of times you can continue to go up is limited. I don't think this works for every patient necessarily, but I am more comfortable with an evidence-based policy that will stand up in court. If a provider desires to pit through a dysfunctional pattern, I will leave that to them and document accordingly.
Nov 5, '07
]I would up the pit and try for something more suitable still get my chart ready for a section sometimes this will ward off a section. Have the provider internalize pt so you can see the real picture of the ctx, monitor her temp and hope things progress.
Nov 5, '07
Presla, great idea on the internals...sometimes the patient is having lot's of contractions with insufficient montevideo units.
Nov 8, '07
Our policy is to back off on the pitocin if more than five UCs in ten minutes. We rarely use IUPCs, but I wish we did more often sometimes to get a more accurate picture of what's going on.
Nov 9, '07
I just got back from a 2 day Conference on EFM by Lisa Miller, CNM, JD. She had lot's of info. on Pitocin management. She said everyone who is administering Pitocin should thoroughly read the ACOG Practice Bulletin called "Dystocia and Augmentation of Labor" from December 2003. Bulletin #49.
Nov 10, '07
i would push the pit as long as the baby is reactive and watch carefully. i also agree with asking for internals.
Nov 17, '07
I just attended an EFM class and we talked a lot about litigation too. The new standard is to NOT "push the Pit" or "pitting through a dysfunctional pattern" or "pitting to delivery or distress." These are not good practices. And when your sitting in a court room in front of a jury with your charting and strip on a big screen being scrutinized you will be happy that you didn't do that. The standard is 6 or more ctx in 10 min. is considered hyperstim and that should be noted in the chart and addressed. Basically the baby isn't getting a chance to recover and receive O2 between ctx with bad patterns. And keep in mind that even though the baby is doing ok right now, eventually you may see the baby not coping well. I think nurses sometimes forget what our purpose is-- the patients (mom and baby) are our number 1 concern. We have to work to support their best interest and health. Not the OB, not the hospital administrators.
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