Pitocin as a secondary on a pump?

[njmcavoy]

Hello all,

We are in the process of revising out pitocin policy for induction/augmentation. We have recently been told that when we set up our IV's we need to have a mainline that will be used for boluses (not on a pump), our normal IV fluid (at 125) is to run on a pump. The question is: Can pitocin be hooked up as a secondary on the pump? the mainline (no pump) would be what would be used for fluid boluses etc. My manager says that this is the way that this is the way that she wants it done (pitocin as a secondary on the pump). Thoughts?? Does anyone else do this? Thank you!!!

[njmcavoy]

This is what we do too. With the pit at the closest port to the patient to minimize the dead space someone else mentioned. We have both fluids (or all three if abx) on the pump.

So you have your IVF's and your pitocin both on the pump?? (and antibiotics if you have them) How do you set it up??

[Spidey's mom, ADN, BSN, RN]

We have double pumps in OB. So one is the mainline fluid and the other is the pitocin, which is attached to the port closest to the insertion site.

steph

[realnurse06]

Most of our pumps have 3 channels. We usually run D5LR on the pump as maintenance fluids and pitocin is also placed on the pump. LR is usually hanging as a bolus and is usually ran wide opened when needed. Some nurses may place the LR on the pump if the patients IV is positional and stops when infusing. There is really no way for us to get around having 3 IV lines when the patient is on pitocin.

[sample24]

We use a triple pump for our labor pts. Main line is usually LR@xxx, next is Pitocin hooked at the port closest to the patient, the third is for antibiotics, mag, etc...

[Spidey's mom, ADN, BSN, RN]

Wow, a triple pump . . cool. We piggyback antibiotics into the NS mainline (it is almost always NS).

steph

[sample24]

We also just re-vamped our pit mix to a 1:1 ratio also which makes it really nice...no more calculations on the spot.

[isabing, ASN]

Our pumps have removable channels. Each pump can control up to four channels. We run everything through the pump. LR@125 is always the mainline. Pit gets a channel and runs into the mainline closest to the vein. Antibiotics run from a secondary above and through the LR channel. The LR does not run when the secondary is running. We start our Pit to run at 2mu/min which is 6ml/hr and then back the LR off to 119ml/hr so the patient does not receive more than 125mls per hour. If we up the pit we back off the LR. If patient is on Mag, we add Mag 50ml/hr + Pit 6ml/hr + LR 69 ml/hr and so on. The antibiotics are not figured into the mess because they usually run at a lower rate.

[CEG]

So you have your IVF's and your pitocin both on the pump?? (and antibiotics if you have them) How do you set it up??

We have triple pumps on our unit.

[rnheart]

To Keep Open, no question is stupid

[eandgsma]

I agree with the last poster. Start your main line fluid with blood/anesthesia tubing and run by gravity at whatever rate is appropriate - the old fashion way, drip count. Then run your pit through the pump and hook into the closest port. There is no need for another bag of fluid - that's just a waste. One bag on anesthesia tubing for mainline and emergencies/bolus and your pit bag through your pump.

This is what we do with regular tubing with ports. The pit is on portless tubing. We have >8k deliveries a year and yes, everyone gets pit. We have cartridges so we can add on to the pump if needed. Usually, we have LR running to gravity and pit to the closest port. If we need to turn off the pit, we turn off the channel (cartridge). There isn't that much left in the tubing going to the patient because its at the closest port. I'd have to measure it but it can't be more than 8 inches of tubing. It would be interesting to really find out how much is in there. Anyway, we run the boluses out of the primary bag of LR. Rarely do we put our LR on a pump, sometimes if we have to run Pen GK we will because it hurts going in. We would always put the LR on a pump for a mag pt though. But we have to dig for channels usually so they are not used as often.

On another subject (but re: pitocin), I so much more prefer it to cytotec. At least we CAN turn off the pit. You can't get rid of a dissolved pill when mom is hyperstimulating.

[CarrieRNC]

I'm new to this site so forgive me if I'm doing this wrong....I have been an OB nurse for 6 yrs and when I was trained i was told that you always run pitocin through a pump on its own line and always attach it to the port closest to the patient. NEVER SECONDARY!! Now I get a new job 4 mo ago at a larger hospital and because DPH and JACHO have been around we now have to run our LR on a pump vs free flow. So some of the nurses there have been piggy backing the pitocin into the LR instead of keeping it on its own line. They will set the primary line at say 119cc/hr and then the secondary at 6cc/hr and titrate as necessary. I am having such a hard time with this because i feel that there is such a huge risk and potential for accidentally bolusing a pt with pit. Now, because the hospital doesnt want to supply us with double pumps, they are rewriting the policy to state that pitocin needs to be secondary to the primary line of LR. I am refusing to do it that way because if feel its not safe. Does anyone know of any policies from awhonn or acog that would support running pitocin on its own line and attached closest to the vein? Thank you in advance!!!

[PCmom]

We have 3 channel pumps. maint. iv is the first channel. Pitocin is 2nd. 3rd only used if pt is on mag or insulin. We hook the mant. in one port of the hep lock and the pitocin in the other. If we need to bolus we just take the maint. off the pump and run it. The maint. also has Anesth. tubing on it in case of emergent c/s.