pitocin after delivery,how do you do it?

SmilingBluEyes · Nov 7, 2002

We mix 20U Pitocin in 1L LR/NS and titrate to bleeding and also to fluid tolerance in the patient....always remembering some have had LITERS Of fluid in labor due to epidural placements or other reason for fluid boluses.

There is where I and O are so important. Sometimes, in cases where bleeding is anticipated (multiple pregnancy or distension due to hydramnios, pt history, etc), we will mix 30 or even 40 units in the sam 1 liter bag of LR.

Interestingly, one place where I work, if a patient is hemorrhaging, we use CYTOTEC, rectally, 4 pills....I know, sounds horrible. But it WORKS! Ute clamps down tight, fast. This is the drug of choice for pp hemorrhage at this place, placing methergine 2nd and we don't even STOCK Hemabate anymore (expensive and in short supply). In every case so far, I have seen PR Cytotec work like a champ.

More than you asked for, Mark, but you know verbose me. That is what I do both places I work, regarding PP Pitocin mixing.

anitame · Nov 7, 2002

We usually use 20 units Pitocin per liter of LR. Sometimes 10, sometimes 30. We titrate the rate to the bleeding, wide open for a few minutes, then titrated down to 125 or so per hour. I usually (is there such a thing in L & D?) have them down to 125 within 2 hours. For a normal SVD they will recieve 1-2 liters postpartum, less if they aren't bleeding much. C-sections usually have Pitocin ordered for the first 2-3 liters.

Anita

HazeK · Nov 7, 2002

Typically, 20 Units/liter of fluid infused rapidly x 10-15 min, then down to 125-200/hr rate until completed....bag hanging at time of delievery plus one more on nurmal patients.

DO use 30+ Units/ltr on pts at risk of fluid overload...run it on a pump.

Haze

luv l&d · Nov 11, 2002

Depends on the situation. Some nurse midwives don't give it at all, some give it IM. Docs, I usually say something like"You've got 400cc up, how much pit do you want?"Gives them an out if they want a liter, or not at all. Cytotec, methergine and hemabate for post partum hemorrage. Unless the pt is on fluid restriction, we usually just "eyeball" it. Most of the time we cap the iv and don't finish the whole liter, unless there is a problem.

finallyRN · Nov 11, 2002

We give 20 units of pit in a Liter running it wide open for about 10-15 mins then 100-150 cc/hour. If they don't have an IV we give 10 units IM. If they are hemorraging we give methergine first, hemabate second (we try to avoid hemabate because of the side effects)

heyabo · Nov 12, 2002

we usually use up what they have hanging which is 10 units in 500cc at an open rate u ntil done with repair and then decrease to about 200cc/hr . The amount depends on the bleeding and the pt's parity. the max they usually get is 1000cc of 10units/500cc unless they are bleeding heavy.

lilyrn1967 · Nov 12, 2002

after the placenta is delivered we run 30 units per 1000cc of rl rapid provided the pt has no fluid restrictions then we mix another bag the same and run at 125/hr till gone then take the iv out provided bleeding is ok. i personally do not always run the second bag the full 8 hours if all is well because the iv is generally the first thing pt's want out.

Q. · Nov 12, 2002

Originally posted by finallyRN
We give 20 units of pit in a Liter running it wide open for about 10-15 mins then 100-150 cc/hour. If they don't have an IV we give 10 units IM. If they are hemorraging we give methergine first, hemabate second (we try to avoid hemabate because of the side effects)

Same here. One doc liked the pitocin to be run when the anterior shoulder is delivered, instead of waiting for placental delivery. He's read studies that show that placental delivery occurs in a shorter time frame than when pitocin is initiated at the anterior shoulder..

NurseDianne, ADN · Nov 13, 2002

It depends on our doc.. :eek: ...all that stuff to remember......LOL

Anyway.......some give 1 amp (10u) push right after delivery and this 1 amp in LR @ 125 cc/hr. Some give the 2 amps in the IVF's at 125cc/hr. Then after the first liter in, determined as to bleeding. Guess it's not an exact science..........

mark_LD_RN · Jan 15, 2003

just a bump:)

imenid37 · Jan 16, 2003

We give 20 units of pit in a Liter running it wide open for about 10-15 mins then 100-150 cc/hour. If they don't have an IV we give 10 units IM. If they are hemorraging we give methergine first, hemabate second (we try to avoid hemabate because of the side effects)

ditto here.

i took a course in sept. that was "totally evidence based", also, and they reccomended pit after delivery of the anterior shoulder. i don't see any of our docs doing this. we do have one dr. who will sometimes if the mood takes him, leave pit running on an induction/augmentation through the delivery of the placenta and then have us open it wide after the placenta is delivered. there seems to be no particular pattern to this. sometimes he'll just say "oh just leave it running." i've seen him do it w/ pit running at just a few mu or 30 mu/min. go figure. he also likes to watch sporting events while doing deliveries.