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Evidence-Based practice re: Pitocin Inductions

Posted

Specializes in L&D.

Help...

I need suggested documentation of studies documenting how/why to run pitocin for induction.

why?

our docs want us to increase pit q15"...

our AWHONN stuff says q 30...so my boss says...

The docs have statistics and studies showing efficacy of "high dose" pitocin, up q15-20, decreasing c/s rate and faster labors....

I need references to show why pit should not be adjusted more often than q30"....IF there are support documents for this.

Please let me know if anyone has any good studies that would be good for us to review!! Our "High Reliability Unit" meets again in 3 weeks to share data and finalize our protocols.

Thanks!

Haze :idea:

Get the new edition of AWHONN's Perinatal Nursing by Kathleen Rice Simpson and Patricia Creehan. The section on pit inductions has a long list of studies supporting physiologic pitocin dosing.

The "fast pit" (as we call it) dosing is part of the active management of labor protocol studied in Ireland - what people forget about that is that the women this protocol was studied on were all nullips already in active labor. You can't take this data and apply it to inducing multips - or nullips for that matter. (Sorry for the soapbox- this is a frequent argument between me and my backup doc :uhoh3:)

Here's a link to the pitocin package insert which says to increase q 30-60 min and dosages over 6 mu are likely to be ineffective and increase the risk of hemorrhage...

http://www.kingpharm.com/uploads/pdf_inserts/Pitocin_PI.pdf

Who does it benefit to have a faster labor? What's the point?

How about setting up a protocol for who can be induced, when, and how if they are truly concerned about the best interest of their patients and not their own convenience?

Thanks for that link. I thought this part of the drug instructions was interesting

"Once the desired frequency of contractions has been reached and labor has progressed to 5-6cm dilation, the dose may be decreased by similar increments 1-2mu/min every 30 60 minutes"

Anyone ever heard of this? We leave it the same if we are happy with progress.

I like to be conservative on Pit and I am uncomfortable titrating without an external monitor.

Thanks for that link. I thought this part of the drug instructions was interesting

"Once the desired frequency of contractions has been reached and labor has progressed to 5-6cm dilation, the dose may be decreased by similar increments 1-2mu/min every 30 60 minutes"

Anyone ever heard of this? We leave it the same if we are happy with progress.

I like to be conservative on Pit and I am uncomfortable titrating without an external monitor.

This was actually part of our Pitocin protocol at the last hospital that I worked with but no one ever did it.

I wonder if it actually works.

PattonD

Specializes in N/A.

Also she told me that they use 10 units of pit per 500 of solution. The report says 10 per 1000. Hmmm.... what do ya'll use?

NurseNora, BSN, RN

Specializes in L&D. Has 52 years experience.

In my hospital we use 30 units of Pit in 500cc on normal saline. Yes, it's very concentrated, but it works out to 1ml/hr=1mU/min, so it is less likely to make a dosing error because of a miscalculation. As a night nurse, I know that I get a little fuzzy on my 6 times table at about 3:30 AM.

NPinWCH

Specializes in Family NP, OB Nursing. Has 15 years experience.

We put 10 in 500. Start at 1 mu and increase by 1-2mu (doc dependent) q 30-40 minutes. We used to start at 2 increase by 2 every 15 and we would almost always end up maxing the pts out (20mu then notify MD with a total max of 30mu). Since we changed the protocol I rarely ever go above 10mu and outcomes are similar.

crysobrn

Specializes in OB L&D Mother/Baby. Has 7 years experience.

We are mixing 10 in 1000, I hate the 6 times tables LOL... We have a conversion cheat sheet on every monitor that says 1mu=6ml/h etc...

I'm curious about the fast pit inductions too. Our docs are VERY eager to up the pit, saying we are too conservative/slow at times. And we also don't decrease it once moms are in active labor as mentioned, only if there is a problem. It's interesting to hear what others do.

HazeKomp, BSN, RN

Specializes in L&D.

we use 30 units in 1000cc D5LR...

we start at 2 mU/min...

we increase by 1-2 mU/min every 15-30", depending on the doc's orders.

Max doseage is 20 to 32 mU/min, depending on the doc's preference.

only decrease for tetanic contractions or fetal distress.

(pretty aggresive pitocin, in my opinion)

Haze

rnWinn

Specializes in L&D. Has 8 years experience.

I am surprised at how different dosing is from place to place (I just finished posting a thread about the same thing when I found this thread). One thing we sometimes do at my hospital if the mom is on fluid restriction is put 20 mu/500 ml. You just have to pay attention because the increments are 1.5 ml/hr - so you have to watch your math!

rnWinn

Specializes in L&D. Has 8 years experience.

"Once the desired frequency of contractions has been reached and labor has progressed to 5-6cm dilation, the dose may be decreased by similar increments 1-2mu/min every 30 60 minutes"

Anyone ever heard of this? We leave it the same if we are happy with progress.

I like to be conservative on Pit and I am uncomfortable titrating without an external monitor.

Actually quite often I will cut the amount of syntocinon in half if the patient is contracting regularly and their water breaks or an ARM is done. Their body seems to take over. And also, I often find that once a woman is fully dilated, especially if they are pushing, the contractions become more frequent and I need to keep turning the oxytocin down. Sometimes I've gone from running it at 16 mu/min to turning it off (incrementally) b/c the cxns keep coming so frequently.

PattonD

Specializes in N/A.

This reminds me of when I was a kid eating watermelon. I would pinch the slimy seeds between thumb and index finger and squeeze hard. The harder I squeezed the further the seed would go.

Maybe the docs want a high dose pit so the baby will shoot out faster and not tend to get "stuck" where a c/s would be necessary?

PattonD

Specializes in N/A.

If the pit keeps getting increased pretty soon the docs will be wearing full baseball catchers gear standing back about 10 ft. from home plate.

tntrn, ASN, RN

Specializes in L & D; Postpartum. Has 34 years experience.

Recently I had a doc write an order to "double the pitocin every 15 min." I was okay doing that from 1 to 2, and 2-4, and MAYBE 4-8, but then I questioned her. I mean, after that it goes from 8to 16 and 16-32! She said she'd been studying for her certification exams and read that doubling is the way to do it. I didn't have time at the time to find out where this documentation is, but that is scary. I wouldn't do it, obviously, and she changed the order when I asked her if she meant that.

Our normal procedure is to start at 2 and increase 2-4 q 15. I don't think docs read AWOHNN.

crysobrn

Specializes in OB L&D Mother/Baby. Has 7 years experience.

I too have a doc that says to "double the pit" Sometimes if a mom is not pushing effectively enough for his liking or if contractions are more than a minute apart he'll tell the nurses to double at that point. It's really sad actually

HazeKomp, BSN, RN

Specializes in L&D.

Maybe the docs want a high dose pit so the baby will shoot out faster and not tend to get "stuck" where a c/s would be necessary?

Yup, the mentality is "faster is better" where I work! Get that bed emptied as fast as possible. Start the pit, place the epidural and blast it out!

sigh :nono:

h.

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