Pitocin induction-pit rates - page 3

what rate do you run pit at for induction/augmentation generally, we start it at 1-2 and go up by 1-2 q15min, with start at 2, up by 2 most common. one doc liked to come in and write to start at... Read More

  1. by   crissrn27
    Quote from rninwch
    OMG!!! That's just crazy, stupid and dangerous for mom and baby. How many PP bleeds do you guys have? After pouring that much pit in the uterus can't possibly even respond the way it should after delivery. Soggy, boggy, hamburger uterus is what we call it here, and those don't respond well to methergine either, usually have to use Hemabate and pray really hard.
    We use hemabate ALOT also have to transfuse alot. do you guys do the 20mu post part.? thats another controversial thing we do to all svd pp pts
  2. by   SmilingBluEyes
    Time for some really some serious case studies, research and doing some evidence-based changing of practice, I think!
  3. by   SmilingBluEyes
    Here is one tidbit from NSO that may alarm you:


    March Legal Case Study
    Child Born With Cerebral Palsy Blames Excessive Pitocin and Failure to Respond to Uterine Hyperstimulation $2.5 Million Settlement.


    http://www.nso.com/case/cases_area_i...d8dcb8b85d1e52
  4. by   SmilingBluEyes
    Does your management keep date/track sheets on cases like this? I know we have to fill out perinatal risk assessment sheets for every baby born where I am..and included in things we track, are pitocin side-effects/hyperstimulation and problems w/neonate, as well as cord pH's etc. Just wondering if data are tracked for perinatal outcomes, if someone is not concerned yet at what is happening where you are?
  5. by   crissrn27
    The only things we track are unexpected outcomes.....like gbs pos untreated with enough time to treat, babies with apgars below 6 at 5 min, unexpected fetal death, I don't do L and D, but work in the nursery so all I know is what is charted on the strip (we have watchchild) as the pit dose. Should I start making notes and give to the manager? something like that?
  6. by   SmilingBluEyes
    I would start asking other hospitals for their pitocin protocols and the ACOG bulletins (if they have them) they base them on. Do some research in ACOG; they have a lot to say about cervical ripening, VBAC and other such things.
  7. by   crissrn27
    Quote from SmilingBluEyes
    I would start asking other hospitals for their pitocin protocols and the ACOG bulletins (if they have them) they base them on. Do some research in ACOG; they have a lot to say about cervical ripening, VBAC and other such things.
    Thanks, smilingblueyes, I am on ACOG website now doing some reading, I WILL be talking to the NM in the near future
  8. by   SmilingBluEyes
    Good luck. I am sorry you have this fight before you.
  9. by   NPinWCH
    Most of our docs like 10units of pit after the placenta is delivered, we have 1 doc that always wants 20.

    We also track our pit use: Reason for use, time pit started, time/type of delivery, was the protocol ordered/used, was pit stopped during labor, why, if pit was stopped was it restarted according to policy (if off less than 1 hr restarted no higher than 1/2 its previous rate if off more than 1 hr restarted at 1mu/min), post partum complications (excessive blood loss or manual removal of placenta) and apgars.

    We rarely have to transfuse. In 12 years I can think of only about 10 times I've cared for someone who needed blood, and some of those times were due to HELLP syndrome or pt's presenting with active bleeding r/t previa or abruptions.
  10. by   nurseob7
    We currently are usually starting our pit inductions/augmentations at 1-2 mu/min and increasing by 1-2mu/min every 15 min . We have to document FHR and uterine activity every 15 minutes along with BP and pulse. The care of the pt is not difficult but the charting is ridiculous -- especially when you have two pit pts ! It is very easy to fall behing on the charting . During my 12 hr shift the pt gets 48 BP's which I think is not evidence based practice. I've never seen blood pressure effected by pitocin, even though I know it could happen. I would like to see 30 min bp's and 30 min fhr and ua documentation. How often do you take bp's with Pitocin? I am going to talk to some of the ob's and hopefully they will approve for this policy to be changed.
  11. by   HappyNurse2005
    Quote from nurseob7
    We currently are usually starting our pit inductions/augmentations at 1-2 mu/min and increasing by 1-2mu/min every 15 min . We have to document FHR and uterine activity every 15 minutes along with BP and pulse. The care of the pt is not difficult but the charting is ridiculous -- especially when you have two pit pts ! It is very easy to fall behing on the charting . During my 12 hr shift the pt gets 48 BP's which I think is not evidence based practice. I've never seen blood pressure effected by pitocin, even though I know it could happen. I would like to see 30 min bp's and 30 min fhr and ua documentation. How often do you take bp's with Pitocin? I am going to talk to some of the ob's and hopefully they will approve for this policy to be changed.
    We also document fhr and uc pattern q15min while on pit, and the bp policy is technically that the bp has to be taken before increasing the pit. Easy enough just to put the cuff on and set it to take q15min. of course, with epidural in place, the bp's do have to be taken q15min, and most moms on pit end up with epidural.
  12. by   nurseob7
    Even though it is time consuming for the nurse to chart frequent assesments, many pts do not like bp's to be taken so frequently. Of course, once they have an epidural, I feel frequent bp's are evidence based, but not with pitocin. Many pts are induced with Pitocin and don't end up with an epidural for many hours. Many times Pitocin all day and a failed induction.

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