Oral and or Buccal Cytotec

  1. It's me again. Any policies and or procedures for administration of oral or buccal cytotec anyone is willing to share? New physician from another state wants to use cytotec and it is up to me to help formulate a policy and procedure. Any help greatly appreciated. E-mail to Caseyrnbsn@aol.com

    My nurse manager wants to see examples from other institutions before we implement our own.

    Thanks All.

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    About Caseyrnbsn

    Joined: Mar '00; Posts: 45; Likes: 1
    LDRP RN Pediatric Clinical Instructor


  3. by   mark_LD_RN
    we have it for oral, never personally given it via buccal route. personally i find cytoec works best placed vaginally, the other routes do not ripen cervix as well.
  4. by   Caseyrnbsn
    Originally posted by mark_LD_RN
    we have it for oral, never personally given it via buccal route. personally i find cytoec works best placed vaginally, the other routes do not ripen cervix as well.

    Thanks Mark for the information.
  5. by   SmilingBluEyes
    I work two places and the two deliver cytotec differently. In one, we give 25 mcg orally every 3 hours or until good labor is established. In the other, 25 mcg is placed vaginally, in the cervical fornix, also every 3 hours til good labor established. Unlike Mark, I don't see one route being more effective than the other. Usually, I see it either working NOT AT ALL or TOO WELL. Does not matter the route, it reacts in the same unpredictable way either way. We have never used buccal cytotec in any place I have worked and I don't think I would want to.

    I watch patients like a hawk in both cases as I have seen HYPERSTIMULATION several times. It makes me nervous because of two things: unlike pitocin, cervidil or prostin gel, it is NOT marketed for obstetric use ( and Searle has put out a strong statement saying as much), and you can't "turn it off" once you give it. It deserves your UNDIVIDED attention and careful monitoring when in use.
    Last edit by SmilingBluEyes on Apr 4, '03
  6. by   ShandyLynnRN
    The last hospital I worked at used cytotec, and is it just me, or does anyone else find that if it DOES work, which was only about 50/50, that the patients had much more pelvic pressure and the urge to push once they reached 6-7 cm???

    Also, that hospital developed a policy right after I left to use cytotec 400 mcg rectally for pp hemorrhage. They said it worked better than pit/methergine combined, and was much cheaper!!!

    My hospital only uses cytotec for IUFD. I don't know the dosages or schedule because it is a recent change, and I haven't done it yet.
  7. by   SmilingBluEyes
    Cytotec is GREAT for PP hemmorhage. We give 1000 mcg (4 tablets) rectally and it works FAST and IS CHEAP unlike methergine and hemabate. I saw it work beautifully after a manual removal of placental fragments and heavy bleeding. Within 1 or 2 min, the bleeding resolved and she was FIRM. it is great. A whole different drug when used postpartum, like pit. Much safer.
  8. by   mark_LD_RN
    thats weird It must just be the area i am from where the route matter

    but seriously when given po it causes cotraction and does not seem to ripen cervix as well. when given po our patients will usually get 4 doses and then get pitted. where as ones given vagianally usually deliver after 2 or 3rd dose never make it to pit.

    have only had 2 failed inductions with cytotec placed vaginally over last yr. and had approx 8 failed via PO route. seems to be the same at the other 2 hospitals in our area.

    the doctors here were ordering it po because the nurses were refusing to place it vaginally. i was the only one at the 3 hospitals that would place it.now it is done on a routine basis.

    and as far as the off label use i was told that the manufacturer had recently changed the off label use. not sure if it is true been meaning to check it out. does anyone know what the most recent literature on it says?
  9. by   HazeK

    Ours limits placement by RNs to demises only!
  10. by   hollybear
    I don't like cytotec myself seen a few get hyperstimed lately. would never feel comfortable using it with a VBAC!
  11. by   1996RN
    I have worked at Parkland Memorial Hospital in Dallas for the past 4 years. We deliver about 15,000 babies per year. We currently use Cytotec 100 mcg PO, and can repeat the dose 4 hrs after the first, as long as there are no significant decels or hyperstimulation. My take on the Cytotec is this: either it doesnt work at all, or it causes major hyperstim and severe prolonged decels. We always know to keep a very close eye on our pts for the first 30 min because of the inevitable "miso decel". Lots and lots of stat sections from Cytotec. It works much better in multips.
  12. by   mark_LD_RN
    I think with doses that high we would see a lot of hyperstimulation here also. we never have given over 50mcg per doses either way. usual way we do it is 25 or 50 mcg vaginally times one doses then 25 mcg q4hours after that, works great that way here. and have had no problems with hyperstim or fetal distress.