Pitocin d/c?

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Specializes in Cardiac, stroke, telemetry,Med-surgical.

Hi all.

I am wondering what your hospital policy says about discontinuation of pit vs decrease pit? When do you discontinue pit?

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Specializes in Almost--.

But pitocin is only used to further progress labor, means it does used only for one-time-setting. It wont take days. Unless it was ordered with lacking assessment and found later that it is contraindicated that it needed to d/c.

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Specializes in Nurse Manager, Labor and Delivery.

Are you talking about discontinuing pit after delivery or during labor? Two different animals.

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Specializes in L&D.

It depends on the situation. You d/c pitocin in case of bradycardia or tachsystole (more than 5 contractions in 10 mins) in cases of nonreassuring tracing. If the tracing is reassuring (which our policy states is moderate variability and/or accels present in the past 30 mins with no more than 2 late decels in the past 15 mins I believe) and there is evidence of tachysystole, you decrease the rate by 2 mu/min. Hope this helps. A lot of it is a judgment call.

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Specializes in Cardiac, stroke, telemetry,Med-surgical.
Are you talking about discontinuing pit after delivery or during labor? Two different animals.

During labor.

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Specializes in Cardiac, stroke, telemetry,Med-surgical.
It depends on the situation. You d/c pitocin in case of bradycardia or tachsystole (more than 5 contractions in 10 mins) in cases of nonreassuring tracing. If the tracing is reassuring (which our policy states is moderate variability and/or accels present in the past 30 mins with no more than 2 late decels in the past 15 mins I believe) and there is evidence of tachysystole, you decrease the rate by 2 mu/min. Hope this helps. A lot of it is a judgment call.

Thank you for your reply.

And in case of 2 late decels and min variability? 2 late decels and absent variability? One prolong decel and absent variability?

And if you decide to decrease the rate of pit, how often do you see recovery, in 60% of cases, 50%, 30%...? What I noticed from reading, if we have a few decels, it usually gets worse with time. Am I right?

I have read a liability case where a nurse was asked about non-reassuring tracing and she said that she had thought that the tracing wasn't that non-reassuring and, therefore, she didn't alert the physician.

This element of subjectivity is concerning...

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At any point the nurse sees any indication of distress, ie decreased variability, decels (early,late,variables) the patient should be assessed. Has she progressed? membranes ruptured? does repositioning help? has she had pain med? what kind and when? Depending on that assessment there are times when it's appropriate to completely stop the pit ie if your assessment indicates a baby and/or mama who is in acute distress. Otherwise the pit should be decreased as already mentioned. Reading the FHR tracing will vary somewhat from nurse to nurse but everyone should know the signs of non reassuring tracing- there's no such thing as not that non reassuring. The doctor should ALWAYS be notified of ANY non reassuring tracings.

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Specializes in OB.

My hospital policy states to decrease pit by half for tachysystole with reassuring fhr, and to d/c pit for non-reassuring fhr (tachysystole or not).

There was a great article in MCN journal last month by Kathleen Rice Simpson "Oxytocin - high alert medication". I think we are going to see stricter standards regarding pit in the future.

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Specializes in Cardiac, stroke, telemetry,Med-surgical.
My hospital policy states to decrease pit by half for tachysystole with reassuring fhr, and to d/c pit for non-reassuring fhr (tachysystole or not).

There was a great article in MCN journal last month by Kathleen Rice Simpson "Oxytocin - high alert medication". I think we are going to see stricter standards regarding pit in the future.

Thank you for the info about article. I'll try to find and read it.

About tachysystole. You have just started pit; the rate is 2 mu/min and you suddenly see tripling and coupling of uterine contractions. Will you d/c pit immediately?

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Specializes in Cardiac, stroke, telemetry,Med-surgical.
At any point the nurse sees any indication of distress, ie decreased variability, decels (early,late,variables) the patient should be assessed. Has she progressed? membranes ruptured? does repositioning help? has she had pain med? what kind and when? Depending on that assessment there are times when it's appropriate to completely stop the pit ie if your assessment indicates a baby and/or mama who is in acute distress. Otherwise the pit should be decreased as already mentioned. Reading the FHR tracing will vary somewhat from nurse to nurse but everyone should know the signs of non reassuring tracing- there's no such thing as not that non reassuring. The doctor should ALWAYS be notified of ANY non reassuring tracings.

Describe "non reassuring" What are the signs of non reassuring tracing?

repetitive late decels and absent variability,

bradycardia and absent variability,

repetitive variable decels and absent variability

??? what is repetitive? 2, 3, 4 decels, with 50% of contractions in 10 min interval??? How long do you wait to d/c pit?

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