Titrating Oxytocin

[SeattleRS24]

Hello, more experienced OB nurses! I've worked on my floor, a high-risk L&D unit, for about 8 months (half of that time was residency training). My OCD personality makes me very anxious about monitoring/titrating oxytocin. For some reason, it makes me really nervous (I know, I know...everyone says that's a good thing). :) I'm just hoping to alleviate some of my anxiety by asking a few questions. Thanks in advance for the help!

When titrating oxytocin using MVUs from an IUPC, if contractions are inadequate (total MVUs less than 150-200?), can you overlook tachysystole because the contractions are less intense? Like, for example, this patient scenario I had last night: Category I baby most of the night, occasional periods with 6-8 contractions in 10 minutes, but total MVUs of 120-140 in 10 minutes. I got a little confused about whether or not I should still increase the pitocin, or if it should be decreased because that uterus was still technically tachy by definition.

I'm curious - what are some of your tips for making this thought process easier? How long do you sit on a strip like this before making a change to the infusion rate? I know when to shut pit off, but the nuances of titration are starting to confuse me. I've gotten some different responses from the nurses at my workplace so I'm opening the floor to a wider demographic! ANY tips about safely managing oxytocin would be appreciated! Thank you again!

[klone, MSN, RN]

It's not tachysystole unless there is also hypertonicity to the contractions. The contractions are not hypertonic if the MVUs are that low. Therefore, yes, I would probably increase Pit. Sometimes increasing Pit will allow a disorganized contraction pattern to organize itself.

The good thing about Pitocin is it has a short half-life. If you go up by one and the baby reacts poorly, you can always go back down or turn it off.

Just make sure your documentation is clear and thorough - MVUs should be documented so you can justify why you're increasing pit in spite of what looks like tachysystole.

Also, you want to look at the woman, nut just the monitor. I've seen women dilate with MVUs that the textbooks state could not possibly cause progress. Yet the woman is dilating. So if the MVUs are low, you should still assess if she is making progress. If she is, why mess with it?

[queenanneslace, ADN, MSN, APRN, CNM]

At my hospital, we do not increase oxytocin if tachysystole is present regardless of MVUs. This is specified in our tachysystole guidelines. I understand the rationale for increasing Pitocin if MVUs are showing inadequate labor, but if you have guidelines that specify otherwise -follow your guidelines.

Also (I know I should cite my sources, but I don't have them in front of me) I believe that the placental oxygenation pathway is interrupted at intrauterine pressures of 30mmHg or greater. Fetuses that have periods of 60 seconds or longer during first stage of resting tone (less than 30mmHg) between contractions fare much better than when they have less than 60 seconds between contractions. This is another consideration when faced with the decision to increase oxytocin.

You need to be able to defend your practice of nursing. And one of the best pieces of advice I got is that taking a conservative approach is less likely to get you into legal trouble.

Now, you might get some angry OB breathing down your neck about not getting that pit cranked up fast enough. So it's your call. I'm more of a fan of following conservative approaches when using Pitocin - because I'd rather not have to "rescue" anyone from the distress we're causing them.

[massbaby]

Hi,

Yes, It is good to have anxiety, and often it is difficult to to titrate oxytocin. As stated in another post, it has a short half life. Remember that tachysystole is more than 5 contractions in 10 minute period, averaged over a 30 minute period. Remember you might of had coupling or tripling which can be indicative of a dysfunctional labor. It can also be a down regulation action of the oxytocin receptor due to excess exposure to oxytocin. All of this makes it so difficult. I always try to remember that ctx that are too close together (whether tacky or not) means the blood stays longer in the intervillous space. The stasis of this blood in the intervillous space reduces the mother-baby exchange. I always try to remember this. Some will stay just "pit through the pattern" I try not to do this!! As stated remember your documentation- You have to state why you went up or down. Unless you have extreme factors to deal with, sometimes I just take a longer time to increase your pitocin. Its not easy as US NURSES are the ones at the bedside pushing those pump buttons, not the providers!

Hope this helps!! :)

[NurseNora, BSN, RN]

As the previous poster mentioned, it's more than 5 contractions in 10 min averaged over 30 min. So if you have a 10 min period with 6-8 contractions, look at the previous 20 min. If you have 15 or less contractions in that 30 min period, you can safely turn up the Pit. Assuming the FHR shows a Category I. Sometimes position change can affect the contraction pattern also. Give that a try too. If the Doc wants the Pit up with a true tachysystole, he can come in and run it while you initiate the Chain of Command?

[SeattleRS24]

Thanks for the help, everyone! Do you have any recommendations for the best fetal monitoring courses that I can purchase online? I see that AWHONN has some.

[massbaby]

look at GE Healthcare by Dr David Miller its about 100 dollars The animation is fantastic and exp