New grad here- Tips on inserting Cytotec?

[Cassideca]

Hi All ! Looking for advice in inserting Cytotec. My OB Dr usually oders 50mcg vag q4hrs x 2. Yesterday, i had the hardest time in a Post Date Primip who was thick, high and fingertip dialation. I had her put her hands under her bum, and head lowered all the way down.

I hold the tiny 1/2 tab btwn my index and middle finger, sparingly using a tad of lubricant. Still yesterday i had to sweep it up both times, and prayed that I got it into the Cervical Os.

Any sugg to make this easier???? My nurses tell me practice makes perfect, and will come in time.

Thanks- Dee:icon_roll

[zahryia, LPN]

Wow, I can't believe you're actually inserting cytotec. I guess you work in a community hospital setting.

[CEG]

Others might disagree with me on this, but I don't think it matters. Studies have shown Cytotec to be equally effective taken orally. In fact inserted lady partslly it is not working directly on the cervix but rather absorbed to work systemically. So while I try to get it as close to the os as possible i dont worry about it.

[bagladyrn, RN]

One hospital I contracted at used the empty gelatin capsules (supplied by the pharmacy) to hold the little partial tablets to make them easier to place. You may want to ask if you could try a trial of this - it really helps!

[QTBabyNurse, BSN, RN]

the hospital i used to work for used these also...they did work extremely well.

one hospital i contracted at used the empty gelatin capsules (supplied by the pharmacy) to hold the little partial tablets to make them easier to place. you may want to ask if you could try a trial of this - it really helps!

[deege58]

We use them too,easier than without but I still struggle!!

[SmilingBluEyes]

A lot of places have nurses inserting cytotec. Not just community hospitals, either.

I take the pill between my index and middle finger, form a "tongs" with these and go up slowly along the small of the patient's posterior lady partsl wall until I find the posterior cervix, and then releave the pill, pushing it gently further til it sits in. This works GREAT for me and I never lose the pill.

I also agree oral or lady partslly, the results have been the same for me. But current literature and guidelines do not support oral administration of cytotec for induction of labor at this time. Too bad. I much preferred giving it this way for obvious reasons.

[FLOBRN]

just note as others have said, the cytotec goes into the posterior lady partsl fornix, not into the cervix. we only ever use 0.25mcg q 4 hours and not usually more than 2 doses. Pitocin of course 4 hours after the last cytotec.

[sls3]

After 22 years you just seem to know these things. I agree this is the best method.

[midwife228]

The last I knew, Cytotec is not approved for IOL no matter how it's done; the manufacturer sent out letters to OB providers about this. That said, I have worked in a community hospital where we used it and we often did use the capsules. We only used 25 mcg and usually only 2 or 3 times. I now am at a large teaching hospital; we have not used it there for many years (had some bad outcomes) other than for fetal demise inductions. We were using tablets but were often finding them still there, whole, when placing the next one. Now the Pharmacy will crush them and put them in capsules for us. For those of you who are are placing Cytotec as nurses, I'm just curious as to what part of the country and what type of hospital setting you work in; here it's strictly physicians or midwives who place Cytotec. Just a guess here from experience - are you being expected to do it because the OBs don't want to be bothered to come in and do it every 4 hours, especially at night? Do you place Cervidil also? Nurses used to here until there were midwives on staff; now I don't think the nurses would be willing to take that legal responsibility, especially since it is off-label and given the litigious nature of OB.