Evidence-Based practice re: Pitocin Inductions

[HazeKomp]

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

[rnWinn]

"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]

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]

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]

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]

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]

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

h.

[Jolie, BSN]

I don't think docs read AWOHNN.

Probably not. But I'm sure that plaintiff's attorneys do.

[HazeKomp, BSN, RN]

I'm sure that plaintiff's attorneys do.

Excellent point!

I'm going to use this in our multidisciplinary meeting!

Our docs do not want to accept AWHONN's position for "conservative pitocin" as valid, but the public is indeed influenced by the perspective!

HHK

[HazeKomp, BSN, RN]

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.

I have purchased the book and it is being shipped as we "speak"...

Also bought the special printed protocol paper from AWHONN on arom/fse/iupc and PITOCIN INDUCTION/AUGMENTATION!

thanks.

haze

[oldagg99]

my hospital uses the 30 units of Pit in 500cc in normal saline. most doctors go 2x2 q 15 min for a max of 36 (there is one that writes the order for a max of 60!!). a few have gone 4x4 and occasionally there are those that go 6x6 (each q 15 min). with the 6x6 we reach a max of 36 in 1.5 hours. i have had pts sit at 36 units for 8-12 hours at a time with little to no change. every once in a while i have seen a nurse make a judgement call and cut it back to 18 or even 9. it's amazing how within a short amount of time a regular (and effective) ctx pattern begins.

does anyone else use a "check-list"? what's included in yours?

[HazeKomp, BSN, RN]

i have had pts sit at 36 units for 8-12 hours at a time with little to no change. every once in a while i have seen a nurse make a judgement call and cut it back to 18 or even 9. it's amazing how within a short amount of time a regular (and effective) ctx pattern begins.

it is not part of policy or protocol, but many of us "old dogs" on the unit will decrease the pitocin by 50% or shut it off x 1 hour & then restart, if pt reaches "max pit" for several hours with a poor response.

As you have seen, often a much more effective labor after lowered dose or uterine receptors "rest" for a while. Have never seen pathophysicological rationale for why this works so well.

[PegRNBSN]

To the poster who asked about refrigerated Pitocin:

Yes it does need to be refrigerated. We keep two vials in every room and these are dated so we know when they were taken out of the fridge. We are so busy that they never go the 30 days.