Pitocin protocol for Inductions

we put 20 units in 1 liter of LR and titrate by starting at 1-2 milliunits/minute (rate would be 3cc/hr on pump) and go up by 1 to 2 milliunits every 30 minutes. We also take vital signs every 30 minutes and constant FHM. We titrate up until adequate (moderate-strong) contractions are occuring in a 3-5 minute interval/pattern). For those hard to read/monitor externally, we are given liberal orders to insert IUPC prn. But I don't use internal monitors unless I really feel they are truly warranted, due to infection control issues. Just my preference. The doctors often are pushing me to place internals, but if I am comfortable monitoring externally, and the patient's labor is progressing,then why use IUPC? anyhow this is more than you asked. Hope this helps!

What are others doing?- What is your concentration? What is your starting dose? How often is it increased? What is your maximum dose? Does anyone use a premixed bag? If so, what is the concentration?

We also mix our own; we put 30units in a 500mL bag of LR for a 1:1 ratio (1 mL/hr= 1mu/min). Our pre-written orders are to start at 2mu and go up by 1-2 every 20 minutes until an adequate contraction pattern is established; the provider can write for us to increase as often as q15 minutes. I can't remember the max dose but we need to consult with the provider/get an order to go above 20. Pt is on continuous monitoring and we also have a CBC and type & screen drawn when starting pitocin.

Deb, do nurses insert internal monitors at your hospital?

yes, we insert internal monitors, both IUPC and FSE.

yes, we insert internal monitors, both IUPC and FSE.

Fascinating- the CNMs and MDs do it at mine. I never would have known it fell under the nurses' scope of practice in some places if not for this site. My learning in my first year out of school has really been enhanced by these message boards and the wonderful nurses here who are always so willing to share their knowledge.

Thanks Deb!

(And sorry to hijack your thread, Jemma!)

it was within our scope of practice in Oklahoma, too, but not until you were practicing 2 years plus. I think that was a hospital policy, however. Here in WA, it varies by hospital as to whether nurses do or do not place internal monitors. It just so happens we do where I work. The other hospital I used to work in, nurses generally DID NOT.

We mix 5 Units in 500 D5LR and start at 1 mu/min. We double every 15 minutes for an hour, then go up 2mU per hour until max of 20 mU without further order, until ctx's are adequate and every 2-3. BP every 15 min until stable on a particular dose, then every 30. Continuous monitoring on Pit. We can place our own IFSE but MD's must place IUPC.

We mix 10 units in 1000 ml's of LR, start at 1 mu/min (6 cc/hr) then titrate the dosage every 30 minutes by 1 mu until a good contraction pattern is noted.

Our Pit is mixed by pharmacy. 10 Units in 1000cc of LR 6cc/miu. It depends on which doctor for start and increase frequency but it usually is start at 2miu increase by 2 every 20min. Our max is 16 buy can go higher with an order. We do vitals with dosage changes or every hour if the dose is stable. Of course continuous monitoring....we do have a waterproof tele monitor though, which is very nice! We can keep our patients mobile.

Beth

We mix 30 units in 1000cc D51/2NS, start at 2-4 mu/min and go up by 2-4 mu/min until adequate (by IUPC) or 42 mu/min.

we are allowed to go up to 30 mu/min, no higher.

We mix our own. 10 units Pit/1000 cc LR, or 20 units/1000 cc LR if Mom has PIH or chronic HTN (double concentrated= 1/2 cc dose via pump)

We have 2 protocols, low dose is 1 mu/min up by 1 mu q 20-30 to a max of 12mu. High dose is 2 mu up by 2mu q 20-30 to a max of 20mu. BP's are taken with every increase, and pt's are on continuous EFM. We do have a telemetry unit so pts are able to ambulate. We can insert FSE's but docs or CNM's insert IUPC's. At our facility,you have to be credentialed to insert them, and even the nurses who are, would rather not. We rarely use IUPC's unless UC's are not adequate to cause cervical change.

What are others doing?- What is your concentration? What is your starting dose? How often is it increased? What is your maximum dose? Does anyone use a premixed bag? If so, what is the concentration?

Aloha Jemma,

We do 20 units of it per 1000ml LR, concentration is 1mu=3cc/hr infusion rate. Augment protocol: 0.5 mu=1.5 cc/hr to start, and increase by 0.5 to 1 mu Q 30-60 minutes,titrating to a good labor pattern. If induction protocol: 1 mu=3cc to start, increase by 1-2mu Q 30-60 mins, titrate the same.

Hope this answers your question.

Aloha,

Tammy