Pitocin after delivery

We have 2 MD's. One prefers 10 units per 1000cc d5lr. We usually give about 200-300cc bolus then put the iv on the pump at 150cc/hr. He usually orders 1-2 bags postpartum. The other MD prefers 20 units of pitocin in d5lr 1000cc same above bolus. However if the patient was an induction--he wants 20 units added to the present bag of d5lr with 10units of pitocin added previously for the induction. I think that is a little much. But I have seen it done several ways. Sometimes if we didn't have time for an IV we have given pitocin 10units IM and it worked great.

What about doubling and tripling the dosage for induction of PIH pts. do you do that?? I know it is necessary for PIH pts., but if there is any communication break down in report it could be too much pitocin.

We put in 20units in 1 liter of LR or NS and run it wide open for a bolus of anywhere from 250-500 cc. If not actively bleeding, we slow it at this point. If hemorrhaging, we massage the fundus vigorously and open it for another 150 or so. I have to say: Be careful about bolusing ANYONE an IV fluid, especially one with pitocin in it. Pitocin is shown in studies to increase one's susceptibility to water toxicity. If someone is bleeding THAT actively, it is perhaps time for next-step measures such as hemabate, methergine or cytotec PR (what we use). Bolusing fluids, especially on people who have had IV's for a long time (think: long labors, inductions, prior boluses for epidural or spinal anesthesia), can be dangerous---- and lead to fluid volume overload and all the sequelae that follow. Be sure you are listening to lung sounds on anyone you give fluid boluses to. I have seen one case of Pulmonary Edema secondary to fluid overload Thank goodness, she recovered rapidly and did fine. However, ONCE is ALL YOU NEED to learn your lesson well.

Stevielynn,

what do you do if for instance, an emergency arises and you have no IV access? To me it would make more since to at least have a saline/heparin lock versus nothing.

I'm with stevielynn. I have never encountered a real problem when going without a heplock. I have had to start some IV's fairly quickly in intense situations, but I still think the rarity of that occurance is outweighed by the benefit to the patients' comfort. I do understand the viewpoint of being prepared, but don't believe it is necessary to give everyone an IV in low risk deliveries.

You can give IM pitocin, methergine or hemabate--- or PR cytotec ---to people without IV access and get GREAT results. We usually heplock people in labor where I work, but for those that refuse it, these interventions are effective. As are plain ole vigorous fundal massage and encouraging infant suckling early on----these are less invasive and very effective, if a nurse is on the ball!:)

SBE

Right on. Mother nature had the remedy for many complications fairly well figured out in the first pace, right?

Pitocin: 20 or 30 Units to a liter, run wide open x 15", then rate at 125cc/hr til liter completed. Usually DC IV at that point.