Pitocin titration

epiphany · Jul 28, 2006

On our floor, I've never seen it titrated much beyond 20 mu/min, and even that's rare. (And I thought our floor was bad). There is research out there - though I don't have it in front of me that says that titration above a minimal amount (around 6-10, I think) does not improve outcome.

RNfromMS · Jul 29, 2006

Our unit uses the 20u of pitocin in 1000cc of D5LR and can titrate up to 32mu per protocol; can go up to 36mu with a doctor order.

Mrs.S · Jul 29, 2006

our standing orders state titrate up to 28 mu/min but per MD order I've seen it as high as 42. we recently had some of our RNs attend a conference where they discussed what a previous poster mentioned, that increasing Pit past 6 or so mu/min is ineffective. the information they shared was interesting.

ragingmomster, BSN, MSN, RN · Jul 29, 2006

we routinely get orders to titrate up to 36-40 mu/min.

but i find that if we get up that high, it just isn't going to work for some reason anyway, and it is time to call a section.

birdsnbees · Jul 29, 2006

Thanks for your comments, I really appreciate it. So 40 is as high as anyone has mentioned here so far.

It seems like these people do often deliver.....the ones at 50+ mu, but I think if the pit was off, they would probably still deliver. Just my opinion.

Another thing is though, it seems like I see more decels, and I'm wondering if it's related to the high rates of pit. I would think receptors would be saturated long before 50 mu's is reached, yet these women often do look hyperstimulated to me, and though the decels are variable in nature, there are often a lot of them, and they are deep. This is just not ok with me. There is nothing in our orders or in the protocol that gives a top number of pitocin titration. I'm feeling uncomfortable with all this.

MemphisOBRNC, BSN, RN · Jul 29, 2006

We mix 20 Units in 1,000 ml, start at 2 mU and increase by 1-2 mU q 15 -30 minutes to a max of 30 mU/min.

htrn · Jul 29, 2006

I can't say off the top of my head how high we have run pit, but we have run it over 50mu. We pit VBACs and do it without IUPCs as we have one doc that will NEVER put in an IUPC, regardless - don't ask unless you want a new oraface! We don't have a top limit in our p&p and none of us are comfortable with the really high rates, esp with no IUPC.

I'm just glad I'm not the only one that deals with this. There have been arguments made that we as RNs can be held liable for even increasing the pitocin - have been told at some conferences to make the MD increase the rate on the pump.

epiphany · Jul 29, 2006

I am very uncomfortable with the abuse of Pitocin to force women into labor, and this is one of the reasons I'm considering quiting L&D.

As of now, while I have my mother on pit, I watch her tracing closely and constantly palpate her. At the sign of an unhappy baby, I get very nervous.

Do you have a guideline for hyperstimulation or hypertonus in your P&P? Our guideline for hyperstimulus is ctx >q2 mins, relaxation 90-120 secs. We don't have a guideline for hypertonus, but AWHONN does. I try to use these guidelines to make my case - but it doesn't make me very popular.

mitchsmom · Jul 29, 2006

deleted......

tdr61 · Jul 30, 2006

I believe the ACOG literature states that Pitocin can be titrated as high as either 40 or 40 mU...I will have to find the exact article that addresses it. I'll pass it along when I find it.

birdsnbees · Jul 30, 2006

I can't say off the top of my head how high we have run pit, but we have run it over 50mu. We pit VBACs and do it without IUPCs as we have one doc that will NEVER put in an IUPC, regardless - don't ask unless you want a new oraface! We don't have a top limit in our p&p and none of us are comfortable with the really high rates, esp with no IUPC. (quote)
Yes that's another thing where I am. IUPC's aren't used very often. It has crossed my mind....are the doctors not using them because they don't want to know how strong/frequent these contractions really are? Also the orders say we are to increase the rate by 6 mu every 10-20 minutes until adequate contractions. The protocol says until cnx are 2-4 minutes apart, but it doesn't matter if they are 2-3 minutes apart, certain doctors insist on continuing to increase, and have been known to come over and increase it themselves, not necessarily mentioning to the nurse that they have done so. (almost everyone gets an epidural, so pain is not so much an issue, but safety IS.)
There are other problems here has well, including nurses being pressured into 'beyond scope of practice' situations.
I'm considering going back where I came from....I don't feel safe.