Pit management

[RNBelle]

Just curious how people manage their pt's on pit. I am new to the game and am trying to soak up all the knowledge I can before I am booted out of orientation. I have taken a fetal monitoring class and have Mosby's Pocket Guide for fetal monitoring that has been wonderful! I just wanted to compare opinions.

Do you bump the pit up when pt's are coupling and tripling their contractions? Or do you d/c it, give bolus, etc? And any other pit management info would be greatly appreciated. Where I work, or more specifically my preceptor's mind set is ALWAYS bump up the pit (unless decels), which I do not agree with in all instances.

thanks!!!!!

[SmilingBluEyes]

When contractions are coupling, if there is sufficient time between them, I absolutely DO bump up the pit. Remember, if you have an IUPC, you can use Montivideo Units to assess just how much uterine activity and rest there is, and make your judgements accordingly. Certainly, if the fetal heart patterns are reassuring, simply bumping up the pitocin can make a difference and break this pattern.

Don't neglect, also, to reposition your patient OFTEN in labor, especially if she has an epidural drip going. Often, persistent coupling/tripling can be a sign of dysfunctional labor related to OP or asynclitic postion of baby. Moving the patient can help correct such problems and help the fetus settle into a better position, e.g. OA. If there is no epidural drip, have the patient get out of bed and sit up in a chair, or squat on the toilet , sit on a birthing ball, get on hands and knees, or rock while standing. Often, you can still monitor them well while in different positions. While a woman may not be moving much, keep mind, her baby is not an unmoving object. The cardinal movements needed for lady partsl birth still have to be accomplished. This is better enhanced by getting the laboring patient moving, also!

Hope this helps.

[macckp]

You should cut the pit back if coupling, etc. Putting pit up is the the old way of thinking. Always have a reassuring FHR with good variability. Hope you enjoy L & D. I have for over 32 years & still LOVE it!

[SmilingBluEyes]

Sometimes, the old ways work. Nothing is "always" or "never". I agree reassuring FHT patterns are a must for pitocin to even be running, let alone turning up rates. And changing maternal positions is critical, as well. I would do this first before turning up the pitocin.

[SmilingBluEyes]

One more thought: KNOW what your policies say and if in doubt, ask your preceptor or the physician or midwife what they think.

[Jolie, BSN]

Can someone explain the rationale for upping pit when a patient is coupling or tripling contractions? It seems counter-intuitive.

[RNBelle]

Thanks for all the tips!

[RNBelle]

From what I have heard it can knock them out of that pattern. But my question is when up-ing to get them out of the pattern, do you just do it once, or where do you draw the line on increasing pit?

[SmilingBluEyes]

Like I said, coupling and tripling are signs of dysfunctional labor. So getting the patient up to walk makes perfect sense. But where I work, people on pitocin must be continually monitored and we don't have telemetry (I wish). And if the coupling is in a pattern is far apart, sometimes you can "break" the pattern by going up just a mu or two of pit. I am not talking about going up radically or rapidly, but slowly and deliberately; and you do not do this if there is hyperstimulation/hypertonus happening. Remember the Montivideo Units, folks. You need to have amplitude (strength) and sufficient frequency to have cervical change. So, sometimes, bumping up pitocin can work.

But if a body is not ready, it's not ready. No amount of pit can change that. That is one of the problems with doing inductions for elective purposes. It puts us up against Mother Nature and she seems to win, so much of the time. I have a saying, push nature too far and she will push you right back. I would love to see more spontaneous labor, myself.

[SmilingBluEyes]

I also said, you do not bump up pitocin if you have sufficient MVU already. Nor do you do it if the uterus is not relaxed between contractions (develop a really good skill at palpating contraction strength, length and frequency) You also do not turn it up in the presence of nonreassuring FHT or tachysystole, or hypertonus; you turn it off and reposition the mom, give oxygen as needed, and administer fluid boluses if needed.

Another reason to hold off, is you are already progressing well in labor! If spaced-out or coupling contractions are bringing sufficient cervical change, then it makes no sense whatsoever to turn up (or on) the pitocin. These are some of the reasons I can think of, you would want to hold off or turn down/off pitocin.

[RNBelle]

IUPCs are rare to see where I work...Don't know if its a physician thing or what. So I guess I need to rely on palpation.

[SmilingBluEyes]

Yes you will need to develop that skill. And you will need to be very good at it. However, not everyone can be monitored safely externally and you need accurate data as it can actually prevent an unnecessary c/s or inappropriate use of pitocin. Do they use internals when contractions don't pick up on the toco for any reason? If not, you risk not running the pitocin safely. Where I work, the nurses place internals, on their discretion. There is one group of doctors who want us to call first, the rest want us to use them as needed (e.g. for large people who don't pick up, etc.)