Pitocin as a secondary on a pump?

[njmcavoy]

Hello all,

We are in the process of revising out pitocin policy for induction/augmentation. We have recently been told that when we set up our IV's we need to have a mainline that will be used for boluses (not on a pump), our normal IV fluid (at 125) is to run on a pump. The question is: Can pitocin be hooked up as a secondary on the pump? the mainline (no pump) would be what would be used for fluid boluses etc. My manager says that this is the way that this is the way that she wants it done (pitocin as a secondary on the pump). Thoughts?? Does anyone else do this? Thank you!!!

[Jolie, BSN]

Maybe I'm missing something obvious here, but why wouldn't you just use your normal IV fluid (from the pump) for boluses?

[njmcavoy]

Because the thought is that if you increase the rate of your primary IV fluids (for a bolus), it will then bolus the pitocin that is currently in the line.....

Also, our pumps will only go to 999ml/hour, and we generally like our boluses to go faster than that..

[Jolie, BSN]

So you will have a line of IVF running directly from the bag to the patient, your "pump" fluids running into the first port on that tubing, and the pitocin as a secondary infusion into the pump tubing?

It seems like having a bolus bag hanging with no control device (ie pump) puts the patient at great risk for unintended boluses of IV fluid. While most labor patients are young and healthy, an unintended bolus of a liter of IVF could have serious complications for some.

[JenTheRN]

Here's what we do: We start the IV with whatever fluid is ordered with a primary line. When the pitocin is needed, it is also on a main line and piggy-backed to the closest port to the vein.

The pitocin must run on the machine. It can't be controlled otherwise.

The other main line of fluid can be put to tko by gravity or placed on a different pump at whatever rate.

If you hang the pit on a secondary line, you can't have the fluid and the pit running at the same time.

[njmcavoy]

Thanks for your replies. Yes, we have a mainline with no pump tubing at the request of our anesthesia department. that mainline is off, doubleclamped unless we need it. If we go down the hall for a c-section, they still have their fluids, you just unhook the pump tubing from that primary line.

SO, you have your mainline that hooks into the 3-way. At the closest available port, you have your pump tubing with your LR at 125. Up at the level of the pump, they want us piggybacking the pitocin into the casette.

[njmcavoy]

Here's what we do: We start the IV with whatever fluid is ordered with a primary line. When the pitocin is needed, it is also on a main line and piggy-backed to the closest port to the vein.

The pitocin must run on the machine. It can't be controlled otherwise.

The other main line of fluid can be put to tko by gravity or placed on a different pump at whatever rate.

If you hang the pit on a secondary line, you can't have the fluid and the pit running at the same time.

That's what I was thinking too. I wanted to run my pitocin on a totally different pump, and hook into the lowest y-site on the line running my IVF's..........they don't want us doing that "not cost effective for all of that tubing----limited availability of pumps" (which I haven't seen to be a problem myself...)

[JenTheRN]

I want to add:

We do our bolusing with the tko fluid (Which is usually LR or D5LR).

It seems really confusing to have three lines all connected to one IV. Sounds like an accident waiting to happen.

[njmcavoy]

I have a dumb question---what is tko?

[Jolie, BSN]

Up at the level of the pump, they want us piggybacking the pitocin into the casette.

How many ml's of tubing is there between the cassette and the patient? It seems like this would create a lot of "dead space", which translates into a time lag between making rate changes in your pitocin infusion and actually seeing the effects of those changes.

[njmcavoy]

that is one thing that I actually never thought about! I'm not sure how much volume is there. I have both a call and an email out to the pump manufacturer to ask them.....because, on the other side of that coin--if you want to shut off your pitocin because of a decel or something, but you still want your IVF's to run, how much do you need to bleed through that line to be ensured that all the pit is gone?

BTW: I work in a hospital where we do about 5000 deliveries a year.....EVERYONE gets pitocin. We're excited if they make it through without.

[JenTheRN]

Our policy is to ALWAYS piggyback the pit to the closest port to the vein. Otherwise, the doses cannot be calculated properly (due to such minute dosing at first) and if the need comes to shut off the pump quickly, you would still have a bunch of pit in the line. (It's an ACOG and AWHONN standard as well.)