Pit management

[RNBelle]

Just curious how people manage their pt's on pit. I am new to the game and am trying to soak up all the knowledge I can before I am booted out of orientation. I have taken a fetal monitoring class and have Mosby's Pocket Guide for fetal monitoring that has been wonderful! I just wanted to compare opinions.

Do you bump the pit up when pt's are coupling and tripling their contractions? Or do you d/c it, give bolus, etc? And any other pit management info would be greatly appreciated. Where I work, or more specifically my preceptor's mind set is ALWAYS bump up the pit (unless decels), which I do not agree with in all instances.

thanks!!!!!

[mitchsmom]

Our MD's usually order us to Pit thru coupling, and it does often work for whatever reason (whether it was really the Pit or something else made it stop coupling).

For details ditto what SBE said (except we can only place FSE's, not IUPC's).

[Sue Damones]

LOL I must be tired today.... because here I am seeing the topic of this thread and all I could picture was it being about how to manage patient's smelly ARMPITS LOL.... I guess that goes to show that I've never worked in OB!

HAHAA

[mitchsmom]

LOL I must be tired today.... because here I am seeing the topic of this thread and all I could picture was it being about how to manage patient's smelly ARMPITS LOL.... I guess that goes to show that I've never worked in OB!

HAHAA

LOL

[imenid37]

Ya know, when women, including us nurses, are sweating it through the contractions, we do need some of the other kind of pit management. Thanks for the laugh!

I have also upped pit through coupling IF the strip is reassuring. Watch it like a hawk and don't forget to factor in cervical change. I do very much agree w/ repositioning, esp. w/ an epidural.Be on the lookout for a really tired uterus and possible PPH, if this is persistent during a long labour w/ pit. Also remember, esp. with an epidural that a full bladder does the uterus no favours. Don't forget to cath if you start seeing coupling or tripling, unless you have a Foley in, which we never do.

[Barkow]

I also have a pitocin technique question - how closely do you follow a provider's order? Most order it to be increased by 2miu every 15-30 minutes, which I feel isn't necessarily enough time to see its full reaction. I was told at FHM class that pit can take an hour to show full effect, and you usually don't need to go beyond 8miu if you do it right. Is this true? Is there any harm to the process if you increase it at longer intervals by waiting a bit to see what the contraction pattern does? It obviously might make the whole thing take longer for some women, but other times I find that a little pit goes a long way and going beyond that would cause hyperstim. Thanks!

[mitchsmom]

I also have a pitocin technique question - how closely do you follow a provider's order? Most order it to be increased by 2miu every 15-30 minutes, which I feel isn't necessarily enough time to see its full reaction. I was told at FHM class that pit can take an hour to show full effect, and you usually don't need to go beyond 8miu if you do it right. Is this true? Is there any harm to the process if you increase it at longer intervals by waiting a bit to see what the contraction pattern does? It obviously might make the whole thing take longer for some women, but other times I find that a little pit goes a long way and going beyond that would cause hyperstim. Thanks!

Our routine orders are written to include "until effective labor pattern", and our policy states something to the effect that >10mu/min is usually not needed (although sometimes it is & we do go higher if needed; we can also often back off once we hit an effective pattern).

So, we have the discretion to maintain/back off when we hit an effective pattern (which we usually consider to be ctx 2-3 min apart and 40-60sec). At the same time, most of our MD's would probably be irked if we weren't cranking it up at just the 1st 30 min mark & they would expect a good reason to have held it (if they realized it, they aren't usually hovering & probably wouldn't know if they didn't specifically ask).

I don't often have to go over 8-10mu/min, and a lot of our girls don't even have favorable Bishop scores for induction, either. I think it takes 30-60 mins to hit most of my pts, but occasionally it hits someone right away. We use 20u/1000LR and start at 2mu/min & increase q30 & I find that it's usually fine to go ahead and up to 3mu/min at the 30 min mark; it seems that if I'm going to have one of those really sensitive girls I'm going to know it at that time already and can hold off if needed. I don't know if others have the same experience or not??

An effective pattern & progressing labor is the goal after all, so as long as you've got that...

[obtech2nurse]

We are supposed to go to 20 mu of Pit and our providers get upset if they walk into a room and do not see 20 mu going regardless of progession of labor. It makes me laugh because the CNM's get the most upset about it. I hardly ever go past 10 mu and only go to 20 when the pt is making no cervical change at all. Once my contx get 2-3 mins apart for 60-80 secs I stop increasing the pit. If they start spacing out, I will increase it more. I am always moving my pt and getting them into different positions. That really helps. If the pt has not made adequate cervical change then I will bump the pit more. I have to defend my actions to the provider (by not having pit at 20 mus at all times) but when I state that contx pattern is reassuring and the pt is making cervical change, the provider will (hopefully) stop complaining.

[imenid37]

Everyone does this so differently. Our docs use 6 mu/min to start and often (cringe) increase by 6 mu q 30 min. Have that methergine ready post delivery because these uteruses get tired. I like our docs mostly, but they are not known for their patience. I am thinking, they too. could read the literature which supports less pit, but they want to hurry up the process so as not to get too many after hours calls.

[zahryia, LPN]

Yikes! A lot of you have mentioned cervical change-which makes sense- but how often are you doing vag checks?

[mitchsmom]

Yikes! A lot of you have mentioned cervical change-which makes sense- but how often are you doing vag checks?

We usually do checks q2 unless needed earlier for some reason; sometimes I stretch mine longer if I don't think they are needed (we have one MD who insists on q2 so I don't do it with her). Our MD's generally AROM ASAP (usually during morning rounds at 8am if at all possible - high & 2cm, who cares?), so I don't feel it's prudent to do more exams than necessary. Just enough to know someone is progressing works for me; no need to up infections for no reason.

Everyone does this so differently. Our docs use 6 mu/min to start and often (cringe) increase by 6 mu q 30 min. Have that methergine ready post delivery because these uteruses get tired. I like our docs mostly, but they are not known for their patience. I am thinking, they too. could read the literature which supports less pit, but they want to hurry up the process so as not to get too many after hours calls.

Holy pitocin, batman! You have more pit going after 30 minutes (12mu/min) than I typically use on entire labor! Are your inductions like 2 hours long???!! You don't have a unit full of exploding uteri? (LOL, sort of!)

[RNBelle]

I have seen some nurses where I work have it cranked all the way up to 36mu and during pushing one of the doc's wants to crank it up more than that (which we don't do). We induce people way to early and crank it up. I personally watch my Pit PTs like a hawk and do not like bumping it up more than needed, and being new I am still trying to find my pit groove.

[SmilingBluEyes]

Studies show "rambo pit" (which is what I call that 6mu jump each time) benefit neither mom nor fetus. Too much too soon can do a lot of damage and does not make things happen more quickly; you often may end up in the OR, stressing out the baby, or overtiring the uterus this way.