UH OB Network MLC 2 Clinical Practice Guideline
Oxytocin Intravenous Administration
See Attachment A. Oxytocin Algorithm
1) Provider responsibility complete prior to initiation of Oxytocin:
a) Complete OB admission history and physical including:
i) Indication for induction/augmentation
ii) Estimated fetal weight within past week
iii) Fetal presentation on admission
b) Prenatal record is available on Labor and Delivery for scheduled admissions
c) Oxytocin order
2) Oxytocin checklist
a) Oxytocin cannot be started unless the checklist can be completed
i) If the checklist cannot be completed, the provider is notified and appropriate
interventions employed.
b) To be performed by RN prior to starting Oxytocin and q 30 minutes throughout labor,
including during the active pushing stage of the second stage of labor.
i) If the criteria are not met in the preceding 30 minutes, Oxytocin cannot be increased
and the RN follows the Oxytocin Algorithm and notifies provider (See Attachment A).
ii) If the criteria are met, the Oxytocin may be increased as per order set.
iii) If the criteria are met, and the Oxytocin is not increased per nursing or provider
management of labor (for example but not limited to, epidural being placed,
contractions are adequate, cervical change is occurring, patient is vomiting), then
patient’s status is re-evaluated in next 30 minute interval.
iv) If criteria are met, and Oxytocin is not increased for two consecutive 30 minute
intervals, then provider is notified.
c) Components of the checklist
i) Date and time
ii) Fetal Heart Rate
(1) At least 1 acceleration of 15 beats per minute (bpm) x 15 seconds in prior 30
minutes or moderate variability for 10 minutes of the prior 30 minutes
(2) No more than 1 late deceleration in prior 30 minutes.
(3) No more than 2 variable decelerations (>60 seconds in duration and decreasing
>60 bpm from baseline) within the prior 30 minutes.
(4) No prolonged decelerations (≥2 minutes).
iii) Uterine Contractions
(1) Five uterine contractions or less, in 10 minutes, averaged in prior 30 minutes
3) Administration
i) High alert-double check medication
(1) Review provider order, concentration, expiration date, patient identifiers, infusion
pump set-up, and IV line set-up with a second RN.
OXYTOCIN INTRAVENOUS ADMINISTRATION GUIDELINES
Owner: UH OB Network
Origin & Approval Date: 1/1/2015
Revised: 1/16, 7/16
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Uncontrolled document – printed version only reliable for 24 hours
ii) Concentration: Oxytocin 30 units in 500 mL of 0.9% normal saline (NS); with this
concentration 1 mL/hour is equal to 1 milliunit/minute
60 milliunits @ 1 mL = 60 milliunits = 1 milliunit
mL
hr
60 minutes
minute
b)
c)
d)
e)
f)
iii) Administered with an infusion pump within the preset settings.
iv) Insert the Oxytocin infusion line into the primary line at the connection site closest to
the patient.
Induction/Augmentation
i) An RN may not initiate, administer, maintain, and/or titrate Oxytocin for any live fetus
less than 23.0 weeks gestation in accordance with current Ohio state law.
Fetal and uterine assessment and documentation
i) Continuous electronic fetal monitoring is maintained during Oxytocin administration.
ii) If the patient is ambulating, use fetal telemetry unit where available.
iii) FHR is continually assessed when continuous fetal monitoring is being used.
iv) Document the FHR assessment at the following intervals by RN:
(1) Every 30 minutes during the latent phase of labor
(2) Every 30 minutes during the active phase of labor
(3) Every 15 minutes during the active pushing phase of the second stage of labor
v) Assessment and documentation of uterine activity occurs simultaneously with fetal
assessment and documentation as outlined above.
Maternal vital signs
i) Pulse, respiratory rate and blood pressure hourly, temperature every 2 hours unless
membranes ruptured or fever, then every hour.
Bolus at delivery of infant
i) Infusion rate is 600 milliunits/minute over 30 minutes then 60 milliunits/minute
(1) Use preprogrammed bolus setting on pump to deliver bolus of 18 units/30
minutes.
Postpartum infusion rate
i) Continues to receive 3.6 units/hour in 60 mL of NS
(1) Use preprogrammed infusion setting on pump to deliver continuous infusion
where 60 milliunits/min = 60 mL/min (See calculation above)
ii) Continue infusion until patient’s bleeding becomes stable.
4) Intramuscular administration (IM) postpartum
a) Oxytocin is given via IM route when the patient has delivered and does not have IV
access or in volume-restricted patients with IV access.
i) The dose for IM oxytocin is 10 units IM X1 after delivery of anterior shoulder of the
baby.
ii) The dose is repeated if needed.
iii) Oxytocin is not given IM for any reason prior to delivery such as induction or
augmentation of labor
5) Provider responsibilities
a) These guidelines do not replace the clinical judgment of the provider. If the responsible
provider believes that continuing the use of Oxytocin is in the patient’s best interest but
the checklist criteria cannot be met, the attending provider must:
i) Assess the patient’s current clinical status at bedside and repeat assessment at
appropriate intervals.
OXYTOCIN INTRAVENOUS ADMINISTRATION GUIDELINES
Owner: UH OB Network
Origin & Approval Date: 1/1/2015
Revised: 1/16, 7/16
Page 2 of 4
Uncontrolled document – printed version only reliable for 24 hours
ii) Communicate the assessment and plan with the patient’s nurse and medical team.
iii) Document the assessment and plan in the patient’s medical record.
b) All CNM patients require consultation with the appropriate attending physician to
continue Oxytocin if all criteria in the guidelines cannot be met.
References
American College of Obstetricians and Gynecologists (ACOG). (2009). Induction of labor. (Practice Bulletin No. 107) Obstetrics
and Gynecology,114, 386-397.
ACOG. (2010). Management of intrapartum fetal heart rate tracings (Practice Bulletin #116). Obstetrics and Gynecology,16(5),
1232-40.
Clark, S., Belfort, M., Saade, G., Hankins, G., Miller, D., Fry, D., & Meyers, J. (2007). Implementation of a conservative checklist based protocol for oxytocin administration: Maternal and newborn outcomes. American Journal of Obstetrics &
Gynecology, 480, e1–e5.
Clark. S, Simpson, K., Knox, E., & Garite, T. (2009). Oxytocin: new perspectives on an old drug. American Journal of Obstetrics
& Gynecology, 35.e1-e6.
Simpson, K.R., & Knox, G.E. (2009). Communication of fetal heart monitoring information. In Association of Women’s Health,
Obstetric and Neonatal Nurses (AWHONN) Fetal heart monitoring: Principles and practices (4th ed.). (pp. 177-209).
Nancy J. Cossler, M.D.
Chief, System Quality for Obstetrics
University Hospitals
Jean Blake, BSN, MJ
System Chief Nursing Officer
University Hospitals
REVISION ELECTRONICALLY APPROVED: 7/25/2016
REVISION EFFECTIVE DATE: 8/15/2016
(MINOR EDIT DATE: 7/27/2016)
OXYTOCIN INTRAVENOUS ADMINISTRATION GUIDELINES
Owner: UH OB Network
Origin & Approval Date: 1/1/2015
Revised: 1/16, 7/16
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Uncontrolled document – printed version only reliable for 24 hours
Attachment A. Oxytocin Algorithm
OXYTOCIN INTRAVENOUS ADMINISTRATION GUIDELINES
Owner: UH OB Network
Origin & Approval Date: 1/1/2015
Revised: 1/16, 7/16
Page 4 of 4
Uncontrolled document – printed version only reliable for 24 hours