Evidence-Based practice re: Pitocin Inductions

beckinben, CNM · Aug 22, 2007

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: )

CEG · Aug 23, 2007

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?

L&DRNJenn · Aug 23, 2007

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.

finallyRN · Aug 26, 2007

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 · Aug 27, 2007

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

Thanks for the link CEG.

In the above article it says the Pitocin should be refrigerated. If not it should be tossed after 30 days.

My wife says they don't refrigerate pit at her hospital. Is this normal?

PattonD · Aug 27, 2007

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 · Aug 27, 2007

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 · Aug 28, 2007

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 · Aug 28, 2007

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 · Aug 29, 2007

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 · Aug 29, 2007

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!