pit after delivery

[elleRN]

I am brand new to L&D on orientation with 2 great preceptors. There is no standard protocol for pit administration after delivery. I asked how they knew how much pit to give considering I did not see an order in the chart nor did I hear an MD order it. One preceptor routinely gives 20 miliunits in 1 liter LR x 2 for all her deliveries. There is a protocol for administering pit for induction or augmentation that requires 30 miliunits in 500 ml of LR. My other preceptor simply leaves that 500 ml bag on after delivery. There is obviously no standard in this. As a new L&D nurse I am a little confused as to what do when on my own. When I questioned the preceptor who runs the 2 liters about it she asked the nurse on charge that day who said it's just something you routinely do and know, this nurse obviously practiced the 2 liter rule as well. I plan on asking the CNS on our floor if there is a documented protocol, but I just wanted to run this by you guys first and see what is standard in your institutions. Thanks!!

[fergus51]

We give 10 units IM with the delivery of the anterior shoulders and that's normally it. If a woman is having heavy bleeding we put 20 units in whatever is left in her IV bag (if she has an IV bag) and let it infuse until the bleeding is undercontrol. No reason to give it X2 as far as I am concerned unless there is problems with bleeding, or if she was an induction with pitocin patient.

[renerian, BSN, RN]

Good thread. WE all can learn from each other. I worked in hem/onc and had my kids before I became an RN so I did not get much OB in school.

renerian

[at your cervix]

Pitocin is a medication and you need a doctor's order to administer it. We have a standing order that says to add 20 units of pitocin to the first liter of fluid after delivery and then add 10 units pitocin to subsequent bags at nurses discretion (depending on pt's bleeding). I would be very concerned that your preceptors are giving pitocin at will with no doctors order at all. You should really check into this because it will be your license on the line if you give meds without a doctors order.

[AlaskaKat]

We always mix our pit the same, regardless of why we are giving it, 20 u per L of D5LR. We don't just give it routinely postpartum, but only for heavier bleeding, with a verbal MD order. If I happen to have pit already hanging from labor I will just open up that bag, it usually doesn't have much missing from it since we run it so slow for labor. If I need another bag I will mix another, but the MD usually writes for 2nd liter PRN. Also, if the mom doesn't have a hep/lock or IV then we will give it IM. We don't routinely start IVs and many moms don't have them, I'll start one postpartum if the bleeding doesn't slow with IM Pit.

[SmilingBluEyes]

Now, surely there is a standing order or protocol for post partum care.......that standing order should include pitocin administration after delivery....usually it's about 15- 20units (sometimes 30) in various mixtures of IV fluid, but the most common I see is LR or NS in a liter. ANYHOW, you should find this information there. If not, get with your NM as to why and GET ONE.......to not have this covered is in essence, practicing medicine w/o a physician's license. I am sure, tho, it is written SOMEWHERE....just some of the experienced nurses have gotten complacent thru the years.

Good luck! Don't ever be afraid to ask questions....and keep doing so til the answers make sense to you! It's how you LEARN!

[RNMom1969]

We routinely put 10 units in 500-100cc LR (whatever is left in bag from labor- if there is less than 55, I will mix a fresh bag) and open the fluid, at delivery of placenta, until bleeding is under control.

If bleeding is heavy, we will add another 10units, but that is MD call, not nursing! The initial 10 units is also MD call, not nursing, but it is expected and we always have it ready to go. Once bleeding is controlled and uterus is nice and firm, I will slow the fluids to about 125cc/hr.

Hope this helps!

Joyce

[luv l&d]

We don't routinely hang any pit. Some of our pts don't get iv's and some actually don't get pit after birth. Depends on the provider. I just say"what do you want to do about pit?" if they have an iv running i add "you've got ---cc's up" That covers it for all deliveries

[parker in arkie]

breastfeeding can cancel out the need for pit unless there is VERY heavy bleeding, can't it?

[fergus51]

Depends on the woman, and for many, not completely because they are bleeding immediately after birth and don't breastfeed so well the first time around.

[finallyRN]

we routinely give 20 units of pit in at least 500cc of whatever is hanging (ususally lr). we can add more depending on the bleeding per our protocol. we give 10 IM if no iv acess.

[mother/babyRN, RN]

We do 10 to 20 units per 1000 cc post delivery, although we have a new doc who swears that he was taught you can put as much as 100 units of pit in a bag( none of us has ever had to deal with telling him that probably isn't going to fly)..One of our nurse managers screwed up with an order, and the pt just happened to have a pp hemorrage (would have anyway), so now the pp orders have been amended with a space that includes a spot that the doc fills in as to how much pit they want after delivery. EVERY one post delivery at our facility, gets pit, usually after the placenta has been delivered. If someone goes too fast for an iv, or arrives about ready to delivery, that person gets pit Im....