[brutusmylab1]

Hi Bethem! Don't feel like a patient extubating themselves was your fault. I have been on the unit as a RN for a year and worked previously an extern for 2 years during school. Some patients are like Hoodini's --they can tongue their tubes out, chew on them and find ALL kinds of ways to get it out. Why someone on here would ask you why a pt was restrained is beyond me. It is releveant why they are used. Don't worry about it and we are only human as well. Being an ICU RN is challenging but rewarding. Hang in there!

[tutu123]

I have been a MICU nurse for 4years and I can tell you that your pt will extubate themselves even if they have restraints on. Dont be hard on yourself. You have only been a nurse for 2 years, it is a learning curve everyday. Many pts can bite the tube, tounge it out or my favorite is to slump down in bed an mange to pull it out. And dont forget that sometimes it is not secured very well. I have worked in both teaching and non teaching hospitals. Drs make mistakes, nurses make mistakes, respitory make mistakes. The point is you are human, remember to relax, take one order at time. And if you are in code do not panic, the pt is already dead, so anything that you do will not make them more dead. The point is just remember to treat the pt not the monitior and one order at time. And you will be just fine. Hang in there it does get better.

[bethem]

Thanks, everyone.

I feel a lot better lately. Today the nurse next to me had 2 patients (we have a 6 bed ICU, and we didn't have ONE intubated patient all day yesterday and today!), while I only had 1, so I was keeping an eye on one of her patients as well.

The patient was having multiple seizures which required IV midazolam to abort. I have never seen a seizure and didn't really know what I was supposed to do when she started to seize. Obviously something kicked in, though, cause I ran to the pt before I even realised and turned her into the recovery position, calmly calling for the doc at the same time, then grabbed the midaz without being prompted while the doc guarded her airway. By the end of the shift, the poor pt had had seven seizures, so I could recognise the early warning signs and get midaz into her before she got too into the seizure. I know this is a little thing, but it makes me feel better! I guess I am learning something/have some critical thinking skills (or, you know, common sense) without realising it.

I think I might just be able to do this, as long as there are always lovely people around to help and mop up my tears!

Thanks again.

[rndick01]

Bless your heart! It's perfectly normal! Don't beat yourself up! For the first few years in ICU after school I just knew I was going to kill somebody because I felt I had no clue what I was doing but 13 years later I'm still there! Feeling better about my knowledge but never knowing everything! Comfort will come with time. Give yourself at least 2 years! It's a lot to learn in a very stressful area and ICU nurses can be harsh! Take a deep breath and keep on going! You'll be fine!

[sicushells]

If she flew everytime, why did she need to be tubed 5 times? Just curious...

[RRT2RN2CRNA]

Originally Posted by diosadelsol

Self-extubations are going to happen whether you like it or not. Some pts are Houdinis, plain and simple!

So true!

We had a guy last week that we re-named David Blaine. He extubated himself 3 times in 2 days!

[OkieICURN]

I want to know where all these people work where vent pts are 1:1. Not that I'm trying to one-up anybody, but I have had 3pts, 2 vented and one GI bleeder getting transfused and on insulin gtt...(granted, not often. Usually when I get trippled one or more have transfer orders)

I just thought this type of acuity/assignments were the norm. I guess if I can handle these pts at my hospital I can work anywhere.

Hang in there bethem. In the hx of the world there has been only one perfect person and many imperfect nurses. Myself included.

[criticalcarenurse93]

I have been a critical care nurse for almost 18 years and there are days I feel the same way......"maybe I should't be an ICU nurse"! But because you have those thoughts, it gives me a good feeling about you! You will do fine...you have the concern for your patients to do the very best you can! Be willing to ask questions, read as much as you can, and strive to take the sickest patients you feel you are capable of caring for with your level of knowledge.

Being a critical care nurse involves compassion, knowledge and basically, a strong sense of common sense! It is our job to be aware and to try to prevent "something bad from happening...and if it does, hopefully it will not be as bad as it could have been"!!!!

Good luck to you!

[neurorachel]

I have had several pts extubate themselves. And I know many who have been nurses for many years who have had that happen...on several occasions. You can always reintubate the patient, and in your case, you actually did him a favor..lol.

Medication errors...I would just be extra extra careful. I really prefer places where you scan the med and then the patient, that way it is almost impossible to make a med error.

Everyone makes mistakes. Don't worry about it.

[RNFELICITY]

Originally Posted by 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.

Then you are lucky my friend.

In several hospitals i have worked in, intubation is not an acutity level that requires a 1:1 ratio. We frequently have 2 tubed patients and sometimes 3 depending on acuity and staffing.

Folks who wnat out their tube will get it out...no matter what you do.