[ghillbert]

Wow, I can't believe how many people electively use physical restraints on tubed patients! I would never restrain a patient unless they've had a near-extubation. I've never had a patient self-extubate. I just can't see how with close supervision (intubated patient at 1:1 nursing) you need to restrain people so often.

[Diary/Dairy]

Originally Posted by bethem

Thanks for replying. I do tend to be quite hard on myself and focus on the things I do wrong, ignoring the things I do well. I'll try to be a bit gentler with myself.

The restraints were on because she had been moving her arms the day before - not close to the tube, but moving enough to make us nervous. Our restraints laws seem to be a bit more lenient than US laws.

Despite being too weak all night to squeeze my hands or give an effective cough, this woman managed to lift her head off the pillow, fold herself almost in half to bring her head to her restrained hands and gave the tube a final yank. She really didn't want it in! My boss was telling me about a man who was fully restrained, trussed up like a turkey, and who managed to extubate himself with his tongue! I guess they find a way if they're that determined!

I had the exact same thing happen to me! That lady was in her 80's and she did it so fast, WHILE I WAS STANDING IN THE ROOM! I never knew little old ladies could be so flexible when they were determined!

[Annony RN]

Originally Posted by ghillbert

I just can't see how with close supervision (intubated patient at 1:1 nursing) you need to restrain people so often.

Unfortunately, who gets 1:1 just because of the vent? The only thing we 1:1 is CVVH and Arctic Sun. Just be happy when you're not taking care of three, I guess. ANd, yes, like a PP sometimes we do that with vents, too. Sometimes it' easiest to take three when you have vents, but yes, you'll need the extrta security of the restraints.

[bethem]

Originally Posted by Annony RN

Unfortunately, who gets 1:1 just because of the vent? The only thing we 1:1 is CVVH and Arctic Sun. Just be happy when you're not taking care of three, I guess. ANd, yes, like a PP sometimes we do that with vents, too. Sometimes it' easiest to take three when you have vents, but yes, you'll need the extrta security of the restraints.

All of our vented patients are 1:1. If they aren't vented, they're 2:1. We never have higher ratios than that in ICU (thank goodness!). I

Thanks to everyone for your responses. After a couple of days, I am feeling better about it. I know what I could have done differently and I am starting to accept that even the Platonic ideal of a nurse might not have been able to stop this lady!

[joeyzstj]

Im sorry, but I actually found some humor in this. Im sure that you did nothing wrong and if this is the worst you can find you criticize youself with then pat yourself on the back. I worked as a Respiratory Therapist for 7 years before I went on to CVICU as an RN. I was VERY aware of the risk of self extubation and took pride in the fact that it hadnt happened to me EVER. I was sitting in front of a room watching a lady who had been deeply sedated for about a week. I had checked and just retied her hands after turning her. Her hands were pretty tight and there was no risk of her reaching the ET Tube. When I turned around to speak to a physician, she woke up, wiggled down sideways in bed (on diprivan) and since she coudlnt get her hand to her head, she got her head down to her hands all without making any noise or the vent alarming. She grabbed the Vent tubing near the Y and pulled the tube and half of the tube tamer off. I couldnt believe it. She did great off of the vent. My point is, things happen..........and most likely this isnt even close to the worst that you will do. Dont let it bother you. It has literally happened to EVERY person I have worked with. Good luck.

[diosadelsol]

Our vents are never 1:1 unless they happen to have an IABP, be on CVVH, or be on hypothermia protocol (arctic sun). But a sick pt doesn't warrant 1:1 nursing just because of a vent. Its not uncommon in our unit to have two vented pts as our assignment. And we don't usually go to restraints unless the pt has shown us that they are a risk for self-extubation. I have had completely awake pts who never once reach for the tube and I have had the "sedated on propofol" pt who has pulled the tube out.

[ghillbert]

Wow, I feel sorry for you guys. I've always had 1:1 for ventilated patients, unless they were longterm, stable ventilated patients who were 2:1.

[Diary/Dairy]

I have never had a vented patient be one to one -

One ICU I worked at they paired CVVH with another vented patients - that was too much.

[calla2114]

The only time a vented patient is 1:1 on our floor is if they are also IABP. Other wise 2:1 and if needed it will get bumped to 3:1.

[bethem]

Originally Posted by joeyzstj

Im sorry, but I actually found some humor in this. Im sure that you did nothing wrong and if this is the worst you can find you criticize youself with then pat yourself on the back. My point is, things happen..........and most likely this isnt even close to the worst that you will do. Dont let it bother you. It has literally happened to EVERY person I have worked with. Good luck.

Aw, I think it's great you found humour in this! It tells me that this isn't the end of the world.

Argh, I don't know how I'll cope when I do do the 'worst' thing if this is how I feel with this mistake...