Management of Oxytocin Infusion PDF

 Outlines Objectives of the clinical section (ILOs). Definition of Oxytocin Action of Oxytocin Uses of Oxytocin Contraindications of Oxytocin Dosage, Rate, and Rout of Oxytocin Administration Guidelines to Ensure Safe Best Practice of Oxytocin...

 Outlines Objectives of the clinical section (ILOs). Definition of Oxytocin Action of Oxytocin Uses of Oxytocin Contraindications of Oxytocin Dosage, Rate, and Rout of Oxytocin Administration Guidelines to Ensure Safe Best Practice of Oxytocin Infusion  Outlines Nursing Responsibilities Regarding Oxytocin Infusion Steps of Oxytocin Infusion Administration Maternal and Fetal Complications of Oxytocin Infusion Nursing Responsibilities For Adverse Effects of Oxytocin Infusion Conclusion. References. General Objectives: At the end of this clinical procedure the student will acquire clinical skills related to oxytocin infusion management Specific Objectives: At the end of this lecture the student well be able to; Define oxytocin. List action of oxytocin. Clarify uses of oxytocin List contraindications of oxytocin Identify the dosage, rate, and rout of oxytocin administration Specific Objectives: Clarify guidelines to ensure safe best practice of oxytocin infusion Describe nursing responsibilities regarding oxytocin infusion Perform the steps od oxytocin infusion administration List the maternal and fetal complications of oxytocin infusion Discuss nursing responsibilities for adverse effects of oxytocin infusion  Definition of Oxytocin Oxytocin is a hormone naturally produced by the posterior pituitary gland to stimulate uterine contractions during labor. Synthetically produced and administered intravenously to induce or augment labor.  Action of Oxytocin Uterotonic Drug. During labor: It stimulates the contraction of uterine smooth muscles to increase its frequency, duration and intensity. During lactation: It stimulates the contraction of the smooth muscle of the mammary gland to facilitate ejection of milk from the breast.  Uses of Oxytocin Uses of Oxytocin in Labor 1. Induction of labor. 2. Augmentation of slow labor progress. 3. Premature rupture of membranes. 4. During cesarean section to be injected into the uterine muscles but after the delivery of the fetus.  Uses of Oxytocin Uses of Oxytocin in Postpartum 1. Uterine atony. 2. Prevention and management of postpartum hemorrhage (PPH). 3. Missed or incomplete abortion.  Contraindications 1. Cephalopelvic disproportion (CPD). 2. Fetal distress when immediate delivery is not feasible. 3. Placenta previa. 4. Unripe cervix (for induction without cervical preparation).  Dosage and Administration Routes of Administration Controlled intravenous infusion (10 units of oxytocin in 1 liter of Ringers lactate or dextrose 5 % in water). Deep intramuscular injection.  Rate of Administration The initial infusion rate for oxytocin during labor is 1-2 milliunits per minute (mU/min) and is gradually increased by 1-2 mU/min every 20-30 minutes until an adequate contraction pattern is achieved.  Guidelines to Ensure Safe Best Practice of Oxytocin Infusion 1. Start at low doses and increase slowly. 2. Always use an infusion pump for precise control. 3. Close monitoring of both maternal and fetal well- being. Continuous fetal monitoring. Regular assessment of uterine contraction patterns and maternal status.  Guidelines to Ensure Safe Best Practice of Oxytocin Infusion 4. Be prepared to stop the infusion quickly in case of complications. 5. Team Communication: Effective collaboration between obstetricians and nurses. Timely intervention when complications arise.  Nursing Responsibilities Regarding Oxytocin Infusion Ensure the following preliminary assessment to start oxytocin administration: 1. Indication for administration is documented 2. Contraindications for administration are excluded 3. Adjust oxytocin infusion as per protocol or physician order 4. Communicate with healthcare team for signs of complications  Prepare the Necessary Equipment Tray Disposable gloves Oxytocin ampules IV bottle of glucose 5%. I.V. stand IV set  Prepare the Necessary Equipment Cannula Adhesive tab Infusion pump Syringe Antiseptic solution Cotton with alcohol +Gauze Iodine Bowl Scissor Label  Wash hands and dry it well. Explain the procedure of using the oxytocin to the mother. Ensure the comfort of the mother (establish safe, quite and clean environment). Bring equipments to the bedside.  Maternal Monitoring Before Starting Oxytocin Infusion 1. Blood pressure 2. Heart rate 3. Temperature. 4. Uterine contractions: frequency, duration, and intensity.  Fetal Monitoring Before Starting Oxytocin Infusion 1. Check the fetal position 2. Monitor the fetal heart rate before starting infusion to get baseline data.  Steps of Oxytocin Infusion Administration Ensure that the woman is on her left side. Connect the woman with fetal monitor to assess fetal wellbeing and to establish a baseline for uterine activity  Prepare the I.V. fluids Dilute the oxytocin ampoule (10. IU) with 10 cm of ringer lactate or dextrose 5%. So, each cm of diluted solution contains 1 IU oxytocin. Insert 5 cm of the prepared dose of oxytocin in the 500 cc I.V. fluid bottle. Make sure that the oxytocin solution is labeled. Connect the I.V. set in the bottle and hang it on the I.V. line stand. Justify the I.V. set through the infusion pump.  Insert the cannula in the right hand and fix it with suitable size of plaster (using cotton with alcohol before insertion to clean the site of insertion) Connect the prepared I.V. fluid with the inserted cannula. Be sure that the right hand in a straight position (changes in arm position may alter the flow rate). Support woman’s hand with pillow under her arm.  Start Oxytocin Infusion 1. Start oxytocin infusion according to hospital protocol or obstetrician’s written orders 2. Assess and record the woman’s blood pressure, uterine contractions (frequency, duration, intensity) and the fetal heart rate before each increase in oxytocin dosage. 3. Increase dosage of oxytocin gradually by 1 to 2 mu/min. 4. Increase the infusion rate by 10 drops per minute every 30 minutes until a good contraction pattern is established (contraction lasting more than 40 seconds and occurring three times in 10 minutes) 5. Reduce oxytocin rate when cervical dilatation reach 5 to 6 cm dilatation. 6. Stop the oxytocin infusion and notify the obstetrician if maternal or fetal complications have been developed. Maternal Complications of Oxytocin Infusion 1. Uterine tachysystole (excessively frequent contractions). 2. Uterine hyperstimulation leading to uterine rupture. 3. Water intoxication (from excessive fluid retention). 4. Hypotension or hypertension.  Fetal Complications of Oxytocin Infusion 1. Fetal heart rate < 100 beats minutes, or >160 beats/ minutes 2. Fetal hypoxia or distress due to uterine hyperactivity. 3. Neonatal jaundice (rarely due to hyperbilirubinemia).  obstetrician obstetrician obstetricia Nursing Responsibilities For Adverse Effects of Oxytocin Infusion Uterine Hyperstimulation: 1. Stop the oxytocin infusion and notify the obstetrician. 2. Administer tocolytics (e.g., terbutaline) if needed. 3. Administer oxygen to the mother and increase IV fluids. Fetal Distress: 1. Stop the oxytocin infusion and notify the obstetrician. 2. Reposition the mother to improve fetal oxygenation. 3. Prepare for emergent delivery if distress persists.  Post Procedure Tasks Record intake and output. Remove the equipments. Wash hand. Let the oxytocin infusion to be completed after delivery with close observation of any signs of postpartum hemorrhage until the dose that is finished.  Conclusion Oxytocin is a powerful tool in labor management, but it requires careful monitoring and dosing. Vigilance in monitoring maternal and fetal well-being is essential for safety. Collaboration and adherence to protocols ensure positive outcomes for both mother and baby.  References Hermesch, A. C., Kernberg, A. S., Layoun, V. R., & Caughey, A. B. (2024). Oxytocin: physiology, pharmacology, and clinical application for labor management. American journal of obstetrics and gynecology, 230(3), S729-S739. Roberts, J. R. (2017). Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care 7th Edition. Elsevier Health Sciences.