Survey about Cytotec

[nurse_maya28]

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?

[LauraLiz]

I can't answer these questions as a nurse, of course, but I was just recently given Cytotec for my IUFD. First, I was not asked to sign a consent form for this, had I known anything about it I might have refused and asked for a different method of induction, the only thing my doctor told me about this drug he was placing was the name of it and that it was originally used for treating ulcers but that they have found it effective in inducing labor.

It was also not very effective for me though. Doctor placed it PV, not sure exactly how big that dose was, but then I was given it PO every 4 hours (nurses only allowed to do PO not PV - the nurse told the doctor this while in my room - he didn't know..lol) I was only given a quarter of a tablet at first, but it wasn't working, so they started giving me a half a tablet for a while, then 3/4, and I think I ended up having a full tablet two times (broken in little pieces - cuz the night shift nurse wanted me to hold them under my tongue and let them absorb that way - it did work better that way than swallowing them) I'm pretty sure I only had it placed PV that first time, the doctor might have done it again the next day but I don't think so...I was worried about so many other things at the time to think about that.

My doctor is a family practice doctor. After he placed the Cytotec he went back to his office, so he didn't stay in house.

I actually feel a little cheated right now that nobody told me anything about this drug when they were giving it to me. Obviously my baby's safety was not a concern, but I would have probably chosen a method of induction that was a little more protective of my uterus if that was possible...I want to keep that around and functioning properly for a while!

That being said...I didn't have any major side effects from it, and I'm sure if it wasn't a IUFD situation they might not have given me that much of it!

Laura

[mitchsmom]

How many births do you do per year or per month? around 1100/yr

How many OB/gyns do you have on staff? 6

How many family practice doctors delivery babies? 0

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

Do nurses place cytotec or do the doctors do it? usually nurses

Are there any nurses that refuse to place cytotec? no

Are their doctors in house during the cytotec induction? sometimes yes, sometimes no (we do not have 24 hour in house coverage but someone is typically there 9-5)

Is the surgery crew in house during cytotec inductions? We staff our own cesareans except for anesthesia, who is in-house during daytime hours and otherwise on-call unless already called in for something else.

If you place cytotec,what was required to train you to place cytotec? Know the policy, learned with my preceptor / get signed off on competency

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

Do you or would feel comfortable placing cytotec? I do it, but I would rather use cervidil since it can be removed. I have the understanding that we don't use that because it is very expensive compared to cyto.

[HappyNurse2005, RN]

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

around 300 per month, sometimes more

how many ob/gyns do you have on staff?

we have an ob/gyn residency program, which has 2 or 3 residents plus their attending in house at all times. so, those 3 at minimum. we also have family practice residency that delivers babies, and 4 private dr's offices that deliver. so, minimum-3. most 8.

how many family practice doctors delivery babies?

our family practice residency does. they don't do too many deliveries. the private fps, not assoc with residents, don't deliver.

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

7-13.

do nurses place cytotec or do the doctors do it?

for lady partsl cytotec, the docs do it. we do give it po, if ordered that way. usually, if they choose to use cytotec, they do it lady partslly. we use cervidil way more than cytotec. except for iufds. those usually get cytotec.

are there any nurses that refuse to place cytotec?

n/a, see above

are their doctors in house during the cytotec induction?

well, b/c the residents and their attendings are always there, there is always a doc there. private docs? not always, but usually.

is the surgery crew in house during cytotec inductions?

we always have a surgery crew-scrub nurse/circulating nurse each shift here, pacu nurse, we have an anesthesiologist on call for ob only in house 24h a day.

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

n/a

is cytotec used on viable pregnancies or only on iufd?

iufds usually get cytotec. viable pregnancies usually get cervidil, if they need cervical ripening. cytotec occasionally. i have seen cervidil x3, then cytotec, then pit (then c/s). we really dont use it all that often.

do you or would feel comfortable placing cytotec?

no, only b/c i've never done it.

[mjb324]

We have 8 obs and 6 midwifes, all of them use cytotec. Some use 50mcg po and some use 25mcg vag. We do roughly 2,000 deliveries per year. We have been using cytotec for at least 6 years. We have standing orders for both vag and po. The nurse administers the first cytotec. We are all very comfortable giving it. We also have guidelines too. The only complications we have run into is hyperstimulation, which was immediately corrected with terb. We use 200-400mcg po for demises with good outcome.