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Survey about Cytotec

Posted

Specializes in L&D, postpartum, nursery, antepartum CLC.

I'm just doing some research on cytotec placement/ inductions. Our Facility is pushing for nurses to place cytotec. We are a small rural hospital (300-400 births a year). We just got a new OB/Gyn who came from a larger hospital that has nurses do almost everything. I am guessing that to get him to sign on with us, they told him we would do all the things the bigger city nurses are doing. Most of us are rather ucomfortable with the idea due to the fact that we do not have any doctors in house during cytotec inductions if the nurses are placing them. We also do not have a surgery crew in house. I was just wondering what you ladies do at your facilities - thanks

How many births do you do per year or per month?

How many OB/gyns do you have on staff?

How many family practice doctors delivery babies?

How many nurses do you have on staff for L&D for each shift?

Do nurses place cytotec or do the doctors do it?

Are there any nurses that refuse to place cytotec?

Are their doctors in house during the cytotec induction?

Is the surgery crew in house during cytotec inductions?

If you place cytotec,what was required to train you to place cytotec?

Is Cytotec used on viable pregnancies or only on IUFD?

Do you or would feel comfortable placing cytotec?

How many births do you do per year or per month? I really do not know the answer to this one. We are a small LDRP.

How many OB/gyns do you have on staff? 4

How many family practice doctors delivery babies? One. He doesn't do many deliveries, so I am not certain if he ever does cytotec inductions.

How many nurses do you have on staff for L&D for each shift? 2-4

Do nurses place cytotec or do the doctors do it? We have standing cytotec orders. The patient must have an IV in place, the Dr. places the first 50mcg and 4 hours later the nurse places 25mcg if needed. These standing orders state what meds to give if the pt. is hyperstimulated.

Are there any nurses that refuse to place cytotec? No, we do it routinely, but we never place the first cytotec.

Are their doctors in house during the cytotec induction? They place then leave.

Is the surgery crew in house during cytotec inductions? No

If you place cytotec,what was required to train you to place cytotec? I learned to place cytotec as I followed a preceptor when I first trained for this job.

Is Cytotec used on viable pregnancies or only on IUFD? Both

Do you or would feel comfortable placing cytotec? Yes.

LibraSunCNM, MSN

Specializes in OB. Has 10 years experience.

I thought Cytotec was found to be an incredibly dangerous drug, that caused ruptured uteruses, hemorrhage, and maternal and fetal deaths. It's still being used? Am I wrong about the findings?

RootedRedwood

Specializes in Antepartum, L&D, Postpartum.

How many births do you do per year or per month? We do between 40-60 usually- small rural LDRP.

How many OB/gyns do you have on staff? On staff at all times? None. We mostly have 1 OB/GYN whose services are rendered at our hospital (there is another who has priveledges but rarely uses them), and one family practice MD with special training to do c/sections. Our "OB on call" is pretty much split between these two MDs.

How many family practice doctors delivery babies? Most of our babies are delivered by family practice MDs and midwives.

How many nurses do you have on staff for L&D for each shift? our unit is L&D/Postpartum all in one so we staff between 2-4 nurses each shift.

Do nurses place cytotec or do the doctors do it? We do PO cytotec for the most part. Very rarely do we do vaginal placement of cytotec. We use cervadil for vaginal placement. Nurses do it if the MD/CNM asks us to.

Are there any nurses that refuse to place cytotec? Not that I have heard of. We do low doses of cytotec- 25mg PO to start, and then 50mg PO q4 for a total of 4 doses (i think).

Are their doctors in house during the cytotec induction? Nope, not necessarily.

Is the surgery crew in house during cytotec inductions? Nope, not necessarily.

If you place cytotec,what was required to train you to place cytotec? n/a since we don't "place" cytotec. But for cervadil, on-the-job learning during orientation.

Is Cytotec used on viable pregnancies or only on IUFD? both

Do you or would feel comfortable placing cytotec? kind of in the middle. Wish we didn't use it for induction at all but since we use low doses and monitor very carefully, I feel pretty comfortable....

QTBabyNurse, BSN, RN

Specializes in Obstetrics/Case Management/MIS/Quality. Has 18 years experience.

how many births do you do per year or per month? 700/year

how many ob/gyns do you have on staff? 3

how many family practice doctors delivery babies? none

how many nurses do you have on staff for l&d for each shift? 2

do nurses place cytotec or do the doctors do it? most of the time the rn's do it, unless the doctor just happens to be on the floor at the time doing an exam, then he will do it.

are there any nurses that refuse to place cytotec? no

are their doctors in house during the cytotec induction? no

is the surgery crew in house during cytotec inductions? not unless it happens during their working hours.

if you place cytotec,what was required to train you to place cytotec? just following the policy and procedures set forth. no specific training other than what us nurses collectively read and researched. know the standards of care for using this medication for this purpose. get consents signed for the use of the medication.

is cytotec used on viable pregnancies or only on iufd? both

do you or would feel comfortable placing cytotec? yes....the only caveat i would offer here is to watch the patient very closely as they sometimes tend to progress quickly. do all the necessary research to do it safely and know what situations you need to be prepared for.

QTBabyNurse, BSN, RN

Specializes in Obstetrics/Case Management/MIS/Quality. Has 18 years experience.

are there any nurses that refuse to place cytotec? not that i have heard of. we do low doses of cytotec- 25mg po to start, and then 50mg po q4 for a total of 4 doses (i think).

i'm sure you meant to say 25 mcg!

rn4babies63

Specializes in L&D, PP, Nursery. Has 12 years experience.

how many births do you do per year or per month? 80-90

how many ob/gyns do you have on staff? 5

how many family practice doctors delivery babies? none

how many nurses do you have on staff for l&d for each shift? 2-3

do nurses place cytotec or do the doctors do it? rn's unless doc happens to be there at the time

are there any nurses that refuse to place cytotec? no

are their doctors in house during the cytotec induction? no

is the surgery crew in house during cytotec inductions? no

if you place cytotec,what was required to train you to place cytotec? hospital policy, vaginal exams, knowlege of medication and side effects

is cytotec used on viable pregnancies or only on iufd? both

do you or would feel comfortable placing cytotec? yes

How many births do you do per year or per month? 250-300 per MONTH

How many OB/gyns do you have on staff? 10 OBs and 1 Perinatologist

How many family practice doctors delivery babies? 0

How many nurses do you have on staff for L&D for each shift? 6+

Do nurses place cytotec or do the doctors do it? Nurses always do it.

Are there any nurses that refuse to place cytotec? The pregnant nurses do not place it, other than that, NO, everyone places it.

Are their doctors in house during the cytotec induction? No.

Is the surgery crew in house during cytotec inductions? Yes.

If you place cytotec,what was required to train you to place cytotec? Education on using it, demonstrate competency in placing it.

Is Cytotec used on viable pregnancies or only on IUFD? Both

Do you or would feel comfortable placing cytotec? Yes, very comfortable.

I have seen very few negative side effects of using Cytotec. Unfortunately, our docs do A LOT of inductions, there are frequently patients that receive cytotec 25 mcg Q4 for 24 hours or more. They often end up in C/S due to failed inductions which is a shame. But negative side effects have been rare on our unit from cytotec. Occasionally there is a baby that won't tolerate labor and needs to be delivered via C/S, but that can hardly be blamed on the Cytotec.

nursejohio, ASN, RN

Specializes in NA, Stepdown, L&D, Trauma ICU, ER. Has 8 years experience.

How many births do you do per year or per month?

About 5000/year

How many OB/gyns do you have on staff?

We've always got a 4 resident team, plus their attending in house. Some nights staff is running the whole board, other times we'll have a decent group of private patients so there will be a few extra attendings in house

How many family practice doctors delivery babies?

We've got a family practice residency program, so they deliver patients. If she goes high risk, they'll consult the OB/Gyn residents, and pass her off to them if she needs a c/s

How many nurses do you have on staff for L&D for each shift?

Depending on census, 12-18. Usually have 3 in triage, 1 float, a couple in high risk, and several more for labor. Oh, plus a charge nurse

Do nurses place cytotec or do the doctors do it?

If we're inducing a pre-viable baby (for lethal anomalies, sick mom-HELLP or whatever) the docs have to place it. For IUFDs or regular inductions, we can put it in

Are there any nurses that refuse to place cytotec?

No, but there are several of us who really don't like it

Are their doctors in house during the cytotec induction?

Yep, we've always got the residents. They'll step in for crashes or precip deliveries on private patients

Is the surgery crew in house during cytotec inductions?

We've got one assigned CRNA for L&D, plus MD backup. We've always got a scrub tech, and usually a nurse to be 2nd scrub if needed.

If you place cytotec,what was required to train you to place cytotec?

Just to know the p&p, checked off by preceptor.

Is Cytotec used on viable pregnancies or only on IUFD?

Both, a lot more for IUFDs though

Do you or would feel comfortable placing cytotec?

I'll do it, but I don't like it, and I'm on those moms like white on rice. I don't trust anything I can't take out or turn off. :stone

iteachob, MSN, RN

Specializes in OB, NICU, Nursing Education (academic).

I thought Cytotec was found to be an incredibly dangerous drug, that caused ruptured uteruses, hemorrhage, and maternal and fetal deaths. It's still being used? Am I wrong about the findings?

It's used all the time as you'll see from the above postings. I had it myself 7 years ago. I'm not implying that there are not risks (such as the ones you mentioned).

RootedRedwood

Specializes in Antepartum, L&D, Postpartum.

i'm sure you meant to say 25 mcg!

yes you are right- mcg.

L&Dnurse13

Specializes in OB. Has 11 years experience.

How many births do you do per year or per month? 400-500

How many OB/gyns do you have on staff? 23

How many family practice doctors delivery babies? none

How many nurses do you have on staff for L&D for each shift? 9-12

Do nurses place cytotec or do the doctors do it? RN's place all doses unless the md happens to be in house

Are there any nurses that refuse to place cytotec? No

Are their doctors in house during the cytotec induction? Yes, we have an attending in house 24 hours

Is the surgery crew in house during cytotec inductions? Yes, CRNA and md in house at all times

If you place cytotec,what was required to train you to place cytotec? Just like a cervical check. The preceptor checks placement behind the RN placing it. Have to have 3 check offs to place independantly

Is Cytotec used on viable pregnancies or only on IUFD? Both

Do you or would feel comfortable placing cytotec? I am comfortable placing it

nurse_maya28

Specializes in L&D, postpartum, nursery, antepartum CLC.

One of you said that you have the patient sign a consent. how many other facilities have the consent forms for their patients to sign? Does anyone have a copy of the consent form that i could get?

QTBabyNurse, BSN, RN

Specializes in Obstetrics/Case Management/MIS/Quality. Has 18 years experience.

one of you said that you have the patient sign a consent. how many other facilities have the consent forms for their patients to sign? does anyone have a copy of the consent form that i could get?

i was the one who said to have the patient sign a consent. our patients signed consents for any induction or augmentation procedure with pitocin and/or cytotec. we just used the basic generic hospital consent form and filled in the information in the blank lines at the top where you have to write in what procedure they are consenting to.

i read somewhere, however, that you should really be having the patient sign a consent that explains they will be given a medication that is not approved for the purpose of labor induction (off label use)....i'd be curious to see if there are any hospitals that go to that extent. this is a great discussion btw! :up:

clydester

Specializes in perinatal, addictions/behavioral health. Has 10 years experience.

A few good sites to visit concerning cytotec studies and its use for labor induction are the world health organization's site http://www.who.int and the cochrane collaboration's site http://www.cochrane.org, which has excellent independent reviews of research material on all kinds of topics, including cytotec induction :).

The pharmaceutical company that produces cytotec is Searle. They have a good bit to say on their website http://www.searle.com concerning the use of the medication in a pregnant population.

Good luck in your research!

HeartsOpenWide, RN

Specializes in Ante-Intra-Postpartum, Post Gyne.

I just got hired and am not working yet so I can not answer all your questions. But I can tell you that one of the reason's I chose the hospital I got hired at was because they DO NOT DO cytotec inductions. Its not off label its against label.

As I am sure you know, Cytotec is misoprostol, the same drug used for medical abortions.

Midwifery today wrote several articles warning against this:http://www.midwiferytoday.com/cytotec/

I did some training at an awesome hospital that I would love to do part-time for some day that used it, but at very low doses which is suppose to be safer. I think I would be comfortable with that, but only they very low dose; but I still wish it was not used at all.

But then again, Pitocin is off label for labor...but most drugs are not tested on prego women...

Edited by HeartsOpenWide

IndigoCarmine

Specializes in L&D. Has 8 years experience.

I'm reeeeeeeaaaalllly surprised that cytotec is still so widespread and doubly surprised that it's used so often in smaller hospitals without an OB on the premises. My current job (6000+ deliveries/year, teaching hospital, understaffed of course!) does not use cytotec except in IUFDs or non-viable inductions. Even though we are frequently DESPERATE for an open labor room we leave cervadil in for up to 24 hours. Our inductions go very slowly, but at least we're comfortable in the knowledge that is a woman hyperstims we can take the cervadil OUT! Other than that, they get pit. We never do mechanical foleys either. It's cervadil, pit or nothing.

My last job placed 25mcg cytotec PV once and then 25mcg more q4 (or was it 6?8?). I think we topped out at 3 placements. So I'll answer for THAT job!

How many births do you do per year or per month? 3000

How many OB/gyns do you have on staff? 1 attending, four residents.

How many family practice doctors delivery babies? NA

How many nurses do you have on staff for L&D for each shift? Supposed to be 8, was always 5 or 6.

Do nurses place cytotec or do the doctors do it? Residents only.

Are there any nurses that refuse to place cytotec? NA

Are their doctors in house during the cytotec induction? Always

Is the surgery crew in house during cytotec inductions? Always

If you place cytotec,what was required to train you to place cytotec? RNs didn't plac eit, and believe me, they would have refused.

Is Cytotec used on viable pregnancies or only on IUFD? Yes, but a far higher dose. PV and PO.

Do you or would feel comfortable placing cytotec? No freakin' way. Not unless there was a surgical team in house.

RootedRedwood

Specializes in Antepartum, L&D, Postpartum.

One of you said that you have the patient sign a consent. how many other facilities have the consent forms for their patients to sign? Does anyone have a copy of the consent form that i could get?

We use the generic consent form that we use for everything else and write in "Cytotec induction of labor".

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