Oxytocin Protocols

[rnWinn]

In Canada, we use Syntocinon rather than Pitocin (same thing, as I'm sure you all know). I have tried to find the usual protocol for Pitocin management online, but can't. I looked it up in a drug book...am I right in thinking the usual dose is 1-2 mu/min q15-20 mins? With a max dose of 20 mu/min? If so, that means you can start it at 2, and be at 20 mu/min within 2.5 hours??? Wow. And the book stated you mix 10 units/1000 ml...is this usual? So you would start it at 6-12 ml/hr, right? What are your hospital protocols? I'm interested b/c I want to work in the states.

Just for interests' sake, our hospital protocol (and throughout Canada in general as far as I know) is similar: mix 10 units/500 ml (normal saline usually) and start at 1 mu/min (which is 3 ml/hr). Increase q 30 mins to a max of 26 mu/min (unless no risk factors like twins, previous c/s or macrosomia/polyhydramnios) - then some docs will allow an increase to a max of 40 mu/min. At my hospital our protocol goes like this:

1 mu/min

then

2 mu/min

then

4 mu/min

then

8 mu/min

then

12 mu/min

then

14 mu/min

and then increase no more than 2 mu q 30 mins until adequate cxns.

(You can increase more slowly if warranted)

[RNLaborNurse4U]

We have 20 units pitocin mixed in 1000cc LR. We have two protocols:

Rapid: Increases are every 15 minutes -- start at 2 mu/min, then 4 mu/min, then 8 mu/min, then 12 mu/min. After that, increase by 2 mu/min every 30 minutes, or until contractions are every 2-3 minutes with adequate cervical change. Max dose is 30 mu/min, but may go up to 40 mu/min with additional written orders.

Slow: Increases are every 30 minutes --- start at 1 or 2 mu/min, increase by 2 mu/min until contractions are every 2-3 minutes with adequate cervical change. Max dose is the same as above.

I hate rapid - it's too much, too fast. Unfortunately, it's usually the protocol that's checked off, unless you have a "gentle" doc or midwife!

[Nicole OB Nurse]

At my hospital, we also have 2 protocols. All pit is mixed 20units to 1000ml LR.

Rapid (most often used): start at 6mu/min (18ml/hr) then increase to 12mu/min (36ml/hr) in 30 min. then increase by 2mu/min q 30 min until adequate labor/cervical change is achieved or a max of 30mu (90ml/hr) is reached.

Slow (rarely used): start at 3mu/min then increase by 3mu/min q 30 min until """" as above.

The rapid protocol can definitely cause some hyperstimulation problems as you can imagine, but the docs prefer it because it gets the labor "jump started" so they can get them delivered by 6pm. LOL.

[NurseNora, BSN, RN]

In my hospital we mix 30Units in 500 cc NSS which equals 1ml/hr=1mU/min as I've mentioned in the other Pitocin use thread. It makes the dose calculations so much easier and safer.

Anyway, each doc has his/her own preferred protocol. Most start at 1mU/min and increase by 1mU/min q15-20min; some start at 2 and increase by 2; some give the nurse the option of increasing by 1-2. My hospital has a maximun dose of 30mu/min, above which the doctor must manage the Pit him/herself.

It seems that when I've worked in large teaching hospitals in the past, we had the most variation in protocols. Seems that whenever a new study was printed in the Green Journal, some resident wanted to try whatever protpcol the study proposed. Just like with everything else in life, there is no one absolute right way to do things.