How does your facility utilize pitocin for post-3rd stage?

We add the 20 units to a liter bag of LR, or if they were a pit induction just open that up and let the rest run in.

If there's no IV access we give 10 of pit IM if she's bleeding on the heavy side.

And one of our OBs and his midwives use 200 mcg of Cytotec PO pretty routinely.

~Kelly

I have also seen an obstetrician that use 1,000mcg cytotec PR on every patient.

Otherwise, the 20units Pit in 1L LR is routine. more if situation warrants

20units pit in 1000ml of NS started wide open immediately after delivery of placenta.

had a family practice doc though who wanted it wide open after delivery of posterior shoulder.

We use 30units Pit/500cc NS during labor, open wide after delivery of placenta. Then add 1L bag of D5LR/20Units Pit wide open.

We usually use 20u of Pit/ 1000L of D5LR X 2 bags. But...it's really nursing judgement on how fast to run it in- some people let it run to gravity, some use the pump (which I do). Usually on the pump we run it at 125ml/hr.

Yesterday I doubled my rate for an hour when a mom started bleeding heavier though (long story- complicated). So it really depends on what's going on as to how quickly we get it run in, but the strength is almost always the same. Overall, nurses use best judgement on this on our unit, and we know what the physician's are comfortable with- so we stay within those guidelines and call if it doesn't work. Hope that helps.

Generally, 30units in 500ml normal saline, rapid infusion (bolus about 200-300ml) or until fundus firm and bleeding scant.

also have done 20 units in 1000ml LR, same rule, rapidly bolusing 200-400ml til firm and not actively bleeding.

We only do 5 units IV push or 10 units IM if there's no IV. We do 20 in 500cc's or 40 units in 1000cc's if the person is having a PPH, is a grandmultip or has a history of PPH's. 5 units IV/ 10 IM is usually adequate and we rarely have problems with it.

We use D5LR 1000 ccs with 20 units Pitocin for induction and after placenta, mixed by pharmacy. Sometimes if really bleeding, add another 20 units to the bag. If hanging for induction, finish that, then one more liter is standard order. For Flytern (above post) do you run into problems in your unit using 2 very different solutions? Ours was standarized to eliminate med errors, when we merged 2 units, one using 10 in 1000 and one using 30 in 1000. I have never heard of pushing any into the line.

baby to breast works best.

had a mom deliver fast in the er. she was planning to bottle feed, but placenta wasn't coming (no iv). i asked her if she was willing to put baby to breast just for the placenta's sake. she agreed. i put baby to breast, suckling well. in about 5-7 minuntes, out came placenta beautifully - uterus clamped down nice as you please - bleeding minimal - nervous er doc was glad for my intervention. mom was much more comfortable and baby was happy to boot.

our maker's design far surpasses ours any day.

20 in 1000mL NS here, wide open after placenta, some of the nurses slow it down after a few minutes if appropriate.

We have one MD who does it IM (who I haven't delivered with yet).

baby to breast works best.

had a mom deliver fast in the er. she was planning to bottle feed, but placenta wasn't coming (no iv). i asked her if she was willing to put baby to breast just for the placenta's sake. she agreed. i put baby to breast, suckling well. in about 5-7 minuntes, out came placenta beautifully - uterus clamped down nice as you please - bleeding minimal - nervous er doc was glad for my intervention. mom was much more comfortable and baby was happy to boot.

our maker's design far surpasses ours any day.

:) when i had my third baby (and a harrowing shoulder dystocia) we realized that my iv was infilitrated just a couple minutes after the birth and the nurse was like "oh, you're fine, you're nursing, i'm not going to restart this". i was cramping away and no troubles.