Pitocin induction-pit rates

[HappyNurse2005]

what rate do you run pit at for induction/augmentation

generally, we start it at 1-2 and go up by 1-2 q15min, with start at 2, up by 2 most common. one doc liked to come in and write to start at 6 and up it by 6 each time. of course, practically none of us would do it that way.....

[NPinWCH]

No it is really 60-70mu and up to 80mu/m. Like I said I don't work directly in L and D but go to all the deliverys-I'm an Rn in the nursery. I didn't know this wasn't the "norm". Our docs would laugh at 8-10mu pit.:angryfire They(at least one of the docs) also still turn the kids upside down and smack them a little after their born. We do things really old school and as much as I've pushed nothing has changed. The older nurses want to get a release form for the moms to sign to keep their babies in their rooms. I would go to another hospital where things are more upto date but this is the only hospital within 60 miles......and I really love working with the new moms and babies. what can I do to get them to change this when I don't work in L and D? I can't just ignore it now that I know its harmful.

OMG!!! That's just crazy, stupid and dangerous for mom and baby. How many PP bleeds do you guys have? After pouring that much pit in the uterus can't possibly even respond the way it should after delivery. Soggy, boggy, hamburger uterus is what we call it here, and those don't respond well to methergine either, usually have to use Hemabate and pray really hard.

[SmilingBluEyes]

........or cytotec, and watch them poop their poor brains out all night long.

I agree; it's a set up for real problems intrapartally,and after baby arrives.

[crissrn27, RN]

OMG!!! That's just crazy, stupid and dangerous for mom and baby. How many PP bleeds do you guys have? After pouring that much pit in the uterus can't possibly even respond the way it should after delivery. Soggy, boggy, hamburger uterus is what we call it here, and those don't respond well to methergine either, usually have to use Hemabate and pray really hard.

We use hemabate ALOT also have to transfuse alot. do you guys do the 20mu post part.? thats another controversial thing we do to all svd pp pts

[SmilingBluEyes]

Time for some really some serious case studies, research and doing some evidence-based changing of practice, I think!

[SmilingBluEyes]

Here is one tidbit from NSO that may alarm you:

March Legal Case Study

Child Born With Cerebral Palsy Blames Excessive Pitocin and Failure to Respond to Uterine Hyperstimulation $2.5 Million Settlement.

http://www.nso.com/case/cases_area_index.php?id=133&area=Hospital&PHPSESSID=cdf87750747b7efb75d8dcb8b85d1e52

[SmilingBluEyes]

Does your management keep date/track sheets on cases like this? I know we have to fill out perinatal risk assessment sheets for every baby born where I am..and included in things we track, are pitocin side-effects/hyperstimulation and problems w/neonate, as well as cord pH's etc. Just wondering if data are tracked for perinatal outcomes, if someone is not concerned yet at what is happening where you are?

[crissrn27, RN]

The only things we track are unexpected outcomes.....like gbs pos untreated with enough time to treat, babies with apgars below 6 at 5 min, unexpected fetal death, I don't do L and D, but work in the nursery so all I know is what is charted on the strip (we have watchchild) as the pit dose. Should I start making notes and give to the manager? something like that?

[SmilingBluEyes]

I would start asking other hospitals for their pitocin protocols and the ACOG bulletins (if they have them) they base them on. Do some research in ACOG; they have a lot to say about cervical ripening, VBAC and other such things.

[crissrn27, RN]

I would start asking other hospitals for their pitocin protocols and the ACOG bulletins (if they have them) they base them on. Do some research in ACOG; they have a lot to say about cervical ripening, VBAC and other such things.

Thanks, smilingblueyes, I am on ACOG website now doing some reading, I WILL be talking to the NM in the near future:idea:

[SmilingBluEyes]

Good luck. I am sorry you have this fight before you.

[NPinWCH]

Most of our docs like 10units of pit after the placenta is delivered, we have 1 doc that always wants 20.

We also track our pit use: Reason for use, time pit started, time/type of delivery, was the protocol ordered/used, was pit stopped during labor, why, if pit was stopped was it restarted according to policy (if off less than 1 hr restarted no higher than 1/2 its previous rate if off more than 1 hr restarted at 1mu/min), post partum complications (excessive blood loss or manual removal of placenta) and apgars.

We rarely have to transfuse. In 12 years I can think of only about 10 times I've cared for someone who needed blood, and some of those times were due to HELLP syndrome or pt's presenting with active bleeding r/t previa or abruptions.

[nurseob7]

We currently are usually starting our pit inductions/augmentations at 1-2 mu/min and increasing by 1-2mu/min every 15 min . We have to document FHR and uterine activity every 15 minutes along with BP and pulse. The care of the pt is not difficult but the charting is ridiculous -- especially when you have two pit pts ! It is very easy to fall behing on the charting . During my 12 hr shift the pt gets 48 BP's which I think is not evidence based practice. I've never seen blood pressure effected by pitocin, even though I know it could happen. I would like to see 30 min bp's and 30 min fhr and ua documentation. How often do you take bp's with Pitocin? I am going to talk to some of the ob's and hopefully they will approve for this policy to be changed.