"upping the pit" with regular ctx's

TXMomRN · Sep 28, 2004

Our hospital protocal for pitocin is to start at 2mu/min and increase every 15 mins till ctx's are 2-4 mins apart and lasting 40-60 seconds. And of course watching fhr patterns and altering care accordingly.

Always safest to follow protocol. I worked in a teaching facility that had a "Pit to distress" motto - up, up, up to 42 (and beyond, at times) - unless the pt was contracting 5x in 10 minutes I wasn't doing my job - but we had immediate surgical support, NICU.... Now I am at a smaller place, protocol only allows us to go to 20mu, for ucs q3 mins with a minute rest between.... (and it works!) Anyway if this becomes an ongoing thing I would talk to the nurse manager and see if policy is due for revision...

Good luck!!

BETSRN · Sep 29, 2004

We only increase our pit every 30 minutes (maybe occasionally 20) by 2 Mu. There should be at least one minute between the contractions, ALWAYS. We ALL stick to that (including the docs). We do NOT pit to distress. That's not the point. Follow your policy and don't ever be afraid to turn your pit off when there is distress. If contractions get too close together, turn the pit down and see ehat happens. Remember, it's your license and the doc sure isn't going to back you in court......... Oh yes, and always palpate the belly fopr relaxation and CHART that the abdomen palpates soft between contractions.

RNLaborNurse4U · Oct 1, 2004

Ok guys... gota question for y'all. I've tried searching the web and unsuccessfull to find an answer. Maybe someone has a link for me or personal knowledge to help.
I've been an RN for 13 yrs, but new to L&D. Our hospital protocal for pitocin is to start at 2mu/min and increase every 15 mins till ctx's are 2-4 mins apart and lasting 40-60 seconds. And of course watching fhr patterns and altering care accordingly. My concern is md's that are pressuring me to increase pitocin infusions despite ctx. that are 1-2,3 minutes apart and of course lasting long enough. I guess i'm still finding it difficult to determine strength of ctx's at time by palpation and that of course i think is somewhat subjective from nurse to nurse or nurse to dr. I am finding it very scary and to increase pitocin infusions when drs are pressuring me. what do you all think? HEEEEEEEEEEELP!!!!!!!!

What is your policy & protocol on pitocin for your facility? Always know and go by that.

As for the doc pushing you to up it when your pt is having UC's q 1-3 minutes - remember, YOU are ultimately liable for your actions. If you up the pit anyhow, and the pt is already contracting q 1-3 minutes, baby could go into distress from hyperstim/hypertonus. Uterine rupture could occur. Yada yada yada. Just because a physician tells you or gives you an order to do something, you must still do what any prudent nurse would do - whether it's to follow that order, or not, depending on the situation.

As for palpation, this is what I go by -

Mild - indents like your nose

Mod - indents like your chin

Firm - firm like your forehead

Also - upping the pit - is the patient making cervical change? If she is, and contractions are adequate (every 2-4 min x 60 sec duration) then the pit should stay right where it is.

DON'T let a doc bully you or pressure you. If you do not feel comfortable with something, check with your charge nurse/your preceptor, and get a 2nd nurse's opinion. You need to look at the entire picture with your patient in OB - it's crucial to the decisions and nursing judgements that you make.

It *WILL* come easier in time, and with experience!

Jen

LizzyL&DRN · Oct 29, 2004

I too have had docs pressure me to up the pit, even if the ctx are adequate. About the only time they shut up about it is if you have an IUPC in and they are satisfied the ctx are adequate. I have heard other nurses on occasion tell the doc, that we are following protocol and if he isn't happy with the way the pitocin administration is running he can sit at the beside and run it himself. I've also found this is one of the main reasons I prefer night shift. Less pit being run overall and less docs around to pester you about it.

SmilingBluEyes · Oct 29, 2004

Jen said it well. Remember, you are responsible for your practice in the end, not the doctor. Upping the pit in an adequate pattern of contractions, as defined by your P and P, is taking a risk you should not be taking, and leaves you open to liability.

rnmi2004 · Oct 29, 2004

As for palpation, this is what I go by -
Mild - indents like your nose
Mod - indents like your chin
Firm - firm like your forehead

My chin is squishier than my nose... :uhoh21:

finallyRN · Oct 29, 2004

like the other posters said Ultimatley if you don't feel comfortable don't do it. If the doc continues to pressure you go to your charge nurse or manager, if they don't support you, find another job!

LizzyL&DRN · Oct 30, 2004

I've also seen one doc go in the room and up the pit himself. And not by 2 mu, by 4, 6, or 8. I've asked him to please not do it, and all he'll say is "I wrote it on the strip." URGHHHH!!! Drives everyone nuts, and usually the other nurses chart what he did and reduce the pit back to what it was originally at. Do you other obrns have trouble with docs that get upset when you turn off the pit for hyperstim? Even if the baby is tolerating ok? I've turned it off when the resting tone with IUPC was 40mmhg and ctx q1-2min and the doc had the nerve to yell at me. I actually wanted to terb her but all the other senior nurses said not to because the baby was ok. That was a stressful night.

shay · Oct 31, 2004

Jen said it well. Remember, you are responsible for your practice in the end, not the doctor. Upping the pit in an adequate pattern of contractions, as defined by your P and P, is taking a risk you should not be taking, and leaves you open to liability.

Ah yup. I pit gently. I don't care. I will totally blow off a doc breathing down my neck about upping the pit and have even said to them "BACK OFF, PIT MONSTER!!" :chuckle But I'm smart-mouthed like that.

Pit gently, I say. I personally think that gently upping the pit gives a better, more effective labor pattern anyway.

Stupid pitocin. I hate that stuff. Necessary evil, IMO.

shay · Oct 31, 2004

One more thing...you need giant brass cajones to be an L&D nurse some days. It takes time to grow them and get 'em big and heavy enough to smack docs around with, but patience, grasshopper....yours will grow. :devil:

moz · Oct 31, 2004

Amen sista Shay! You either grow 'em or get out of L&D.

We up the pit by 1 every 15 minutes usually. We accuse day shift of keeping the pit at the lowest possible rate so they don't deliver until nights. One doc starts at 1 then increases by 2 every 20 minutes until at 9mu/min then ups by one every 15.

I personally have never had a doc come in and up my pit, but have been told to up it but not by more than 1 at a time.