We just started using Pyxis and a recent survey we were told that nurses in LD should not be mixing pitocin, nor mag. We should use standard premixed bags of these meds.
What mixture of pitocin do you use? Is it standardized?
What strength of Mag sulfate is used as bolus and then maintanence doses?
Obviously, who mixes it in routine situations? What does your hospital consider "emergeny" criteria which allows the nurse to mix these?
We're really trying to find a way to comply with the new pharmacy standards the rules folks are pushing.
We mix our own pit, 10u pitocin in a 500cc bag of D5. Our Mag comes premixed from the pharmacy, 40g in a 1000cc bag of H20. We bolus anywhere from 4-6 gram load, then usually start out at 2g/hr.
Pharmacy does both now. We used to mix our own pit. At my old hospital we mixed it all pit, mag and antibiotics.
Like so many things haveing pharmacy mix your meds is both good and bad. It's nice not haveing to rember dilution ratios for mag and all the differnt antibiotics and pharmacy is suposedly responsible if they miss label or miss mix a drug. The down side is that you we have to wait for mag to come up from pharmacy and this can be stressful when you have 26 week PTL who you are trying to stop. Another thing is that I think there are some mistakes made on our pit, some bags seem weeker while others seem stronger. At times I've had pateints up to 20 mu with no effect then changed out the bag and had hyperstem.
Haveing pharmacy mix our drugs has taught me that I am in fact, a control feak. I used the think I was'nt but it kind of bothers me to not know for sure that something is mixed properly and I detest having to call them when they forget to send refill mag bags or antbx up.
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We had a JCAHO survey in June 2004 and the nurses mixing pit thing was OK at the time. Surprisingly.
Our surveyers told us all these meds needed to be mixed in pharmacy. Just 2 months later, that is how it went. Funny how they focus on different things at different times. I do know it's one of their "special interests" these days. They made that clear enough.
As far as being a control freak, I understand. I hate when meds are not on the unit when I need them, too. Fortunately that is not all the time. And at night, we have to mix our own ABX as, in particular, Ampicillin is unstable once in a fluid medium. So you have to mix and use within 30 minutes.
It works well as long as the meds are available on the unit when needed. That is the real trick.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Pharmacy does both now. We used to mix our own pit. At my old hospital we mixed it all pit, mag and antibiotics.
. Another thing is that I think there are some mistakes made on our pit, some bags seem weeker while others seem stronger. At times I've had pateints up to 20 mu with no effect then changed out the bag and had hyperstem.
Haveing pharmacy mix our drugs has taught me that I am in fact, a control feak. I used the think I was'nt but it kind of bothers me to not know for sure that something is mixed properly and I detest having to call them when they forget to send refill mag bags or antbx up.
I don' tknow if it's the meds that trouble you, or the individual oxytocin receptors in each woman. They can vary in their response to pitocin by person and even by hour or situation. Had a lady Friday night who was doing fine for two or three hours on 7 mu/min when--- all of a sudden, she began to hyperstimulate massively and I had to turn the pitocin off for 30 minutes. I then turned it back on at half-dose when her contractions predictibly conked out to every 8 minutes. She went from nearly 300mvus to zilch in 30 minutes. And, I eventually had to go up to the same 7 mu/min just to get her labor back into an adequate pattern.
All of this was the same person, same bag of pitocin (30units in 500cc NS) and she had come in with her membranes ruptured. (so this was not triggered by ROM during labor). Nothing had changed that I knew about except a sudden and hard to explain run of hyperstim.(and a predictible run of mild late decels).
So, I have come to the conclusion long ago (when I was still mixing all my own pitocin and mag)---- it is probaby the individual oxytocin receptors and circulating endoginous oxytocin at any given time we are finding varies, not the medication itself.
I don' tknow if it's the meds that trouble you, or the individual oxytocin receptors in each woman. They can vary in their response to pitocin by person and even by hour or situation. Had a lady Friday night who was doing fine for two or three hours on 7 mu/min when--- all of a sudden, she began to hyperstimulate massively and I had to turn the pitocin off for 30 minutes. I then turned it back on at half-dose when her contractions predictibly conked out to every 8 minutes. She went from nearly 300mvus to zilch in 30 minutes. And, I eventually had to go up to the same 7 mu/min just to get her labor back into an adequate pattern.
All of this was the same person, same bag of pitocin (30units in 500cc NS) and she had come in with her membranes ruptured. (so this was not triggered by ROM during labor). Nothing had changed that I knew about except a sudden and hard to explain run of hyperstim.(and a predictible run of mild late decels).
So, I have come to the conclusion long ago (when I was still mixing all my own pitocin and mag)---- it is probaby the individual oxytocin receptors and circulating endoginous oxytocin at any given time we are finding varies, not the medication itself.
Very true its hard to isolate the real cause.
I've seen the same thing you describe without changing a bag of pit. Still the control freak in me offten wonders "how much pit am I really giveing when I use those premixed bags". =P just one of the many manatefations of the mental problems I have which drove me to be an L&D nurse in the first place =P.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Let the control freak go, Dayray. You are still relatively new to nursing, I know but, trust me. It will burn you out. Try to worry about only what you truly can control. Know the differences. And, Let the rest go.
Hey everyone!! Thanks for the insight and the answers. I wasn't sure how other places did their meds.
I don't like other people mixing my meds either so I know it's the control thing. I understand that it isn't the same level of care if I don't mix it in a laminar hood: BUT I DON'T REALLY CARE.... I know what I'm mixing and how.
I, too have seen pitocin look like water then have a massive decel and tetany. Odd thing, the human body!
Thank you again for the input. I wonder where your pharmacy get the premixed bags of pitocin. Our pharmacist hasn't found a source. Do you know the IV solution vender? I'm surprised that you have 40 in 1000 for the mag. Our director is having major palpatations about 20 in 500. Thinks it will get away from us and have fatal results(as well it could, but geez, what's my job if not to watch out for that kind of error?).
Up until recently we had to mix our own pit-10mg/500cc LR until just this last month when our pharmacy started using premix pit. We have always (at least since I've been an RN-6 yrs) had premixed mag from pharmacy. I really wouldn't want to mix that. It really has to be exact. We usually start of with a 5gm bolus over a 30 min period and then 2gms over a 1hr period. Emergancy ? most of the time our emergancy occur when the pharmacy doesn't get the order in soon enough for the dr. We then will just over-ride the system in the pyxis and get the fluids ourselves and either mix it as per our protocol or get the pre-mix, but only with pitocin, never with mag. we don't even have the magnesium on the floor I think that any situation on our area is considered an emergancy when it has to do with what I want when I want it at the time that pharmacy doesn't think that it is an emergancy to them!
Because all mixed meds should be done under a "hood" our pharmacy has begun to mix all our meds. Our pitocin for induction is 30 units in 500 cc 0.9% NSS. To give, for example, 1 mu/min, the IV pump is set at 1 ml/hr. 2mu/min is set at 2 ml/hr, etc. For post delivery, we generally run in the rest of the pit bag. If the patient does not have pit going, our post-delivery pit is 20 units pit in 1000 ml.
Pharmacy also mixes the mag. We use the Omnicell instead of Pixus, but the premixed meds work well with either system. We still keep some pit vials in the Omnicell, in case we need to give it IM. Gail
Jessica76
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We mix our own pit, 10u pitocin in a 500cc bag of D5. Our Mag comes premixed from the pharmacy, 40g in a 1000cc bag of H20. We bolus anywhere from 4-6 gram load, then usually start out at 2g/hr.