does anyone do low dose pit inductions? we use it often they bring patient in a 5 pm we start pit a 1mu go up 1mu every 30 minutes stop at 2 or 4 mu depending on doc.do this all nightthen at 5 am start regular pitocin induction.
what do you think about it? does it work for YOU?
Aug 4, '02
we have not done this the two places I work....but it makes sense if you consider you must get the patient's oxytocin receptors to "accept" exogenous pitocin. I think it could be VERY effective and would lessen the chances of pitocin and fluid overload, which can be common complications in aggressive use of pitocin.
Frankly, I use my judgement whenever using pit. I often increase levels less frequently than protocols call for (1 mu about every 10-15 minutes) and give them time to "absorb" it..... I have found at times, when pit is increased too rapidly, it can lead to hyperstim, when it "catches up with us". Anyhow, I find "going slow" very successful, but selling this to the doc's can be a challenge when they have a "time schedule" in mind.
Are you using "low dose" pit on people with very favorable cervices? I was just wondering......
Aug 4, '02
some are and some are not. the ones with favorable cervix seem to do pretty good. the other its just a waste of time i have found. most of them on the 2 mu to 4 mu dont even ctx, and it does nothing to ripen the cervix.
Aug 5, '02
Well Mark, to me pitting a pt. with an unfavorable cervix is like hitting a BRICK wall. I don't see the point. But they do it, I know.
In the age of "social inductions" we see this all the time. I don't agree with it; I am always prepared for complications as a result. (and you see them often, as you are aware). I wish we could let women's bodies do what they are designed to. Unless medical conditions dictate (of mom or baby) I cannot understand why we are pitting so many anyhow. I totally disagree w/it!
Aug 5, '02
We almost always use prostin for induction, but will go to pitocin if that doesn't work and if the cervix is ripe. Doesn't do diddly, IMHO, if the cervix isn't ripe. We start at 1-2 mu/min and increase by 1-2 q 15-30. Seems to work to get them into a good pattern.
Aug 5, '02
It has been my experience (16 yrs now), that the uterus CAN become "worn out" so to speak, with this method. I wonder if there is any official literature on this? As previously mentioned, there all various factors involved; i.e. a RIPE cx. Even when ripe, a prim ip will tend to end up a section with the slow route! Just my experience tho'! It just proves we don't need to interfere unless there is a serious medical necessity, not wanting a baby on grandpa's birthday!!
Aug 6, '02
the docs where i work like what they call aggressive protocal. we start pit at 2 and then go up by 4 every 15 minutes. need order to go over 40mu. the problem i have is the orders state to increase until labor pattern established -- 5 contractions in 10 min. however i have been yelled at several times by doc when i stop increasing. example sunday pt was up to 14 and i was not incraesing because ctx every 1-2 min. not getting the 60 sec rest and starting lates. however doc mad called house supervisor and then called my manager stated pt should have already been to 40 units and only at 14 etc. so who do you think always gets in trouble? the nurse.
Aug 6, '02
What about the importance of a good nights sleep prior to the "real" induction?
We have had some results (better, I should say) with geling or Cervidil the night before the induction (1 q 20 mn). If cervix isn't favorable, forget the induction IMHO!
Aug 7, '02
We start at 2 mu and up by 1 or 2 every 15 minutes until we get specific contraction frequency, duration and resting tone (and mmhg), written on special orders by ordering physicians. They all have different ideas so we have standing orders with blanks that they fill out. Mostly up to nursing discression. For instance, I have had a doc tell me to up the pit when I didn't like the resting tone or the FH and I have turned it off or down whatever they say because with me the patient and my license come first.
Aug 9, '02
We have never done this, but we have on MD that when pt's come in during the night in prodromal labor and are full term or post dates and want to be induced, he will have us start pit at about 0400 or 0500 but the labor often goes on all day. This may be an option for them so that they could deliver earlier in the day. My question is, why do people always come in at 2300-0100 and say "why won't he just induce me??" I guess people don't understand that no doc in is right mind is going to start an induction that would make him have to lose half a nights sleep!!!
Aug 12, '02
Hi, Jama . . .
I just responded to your post I just read in the Oncology nursing section. I hope everything is going well with your mil.
Aug 19, '02
Hi! I am new to this forum. We use low-dose pitocin alot. We also use alot of cytotec (25-50mcg po or rectally q4) But our policy states that cytotec cannot be given if pt is having greater than 3 ctx in 10 min. If that is the case, the docs usually op for low-dose pit.
Aug 19, '02
WELCOME to you sleepy! We look forward to "seeing" more of you soon!
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