[birdrecruit]

Our team is caring for a patient with anorexia who is fitted with a naso gastric tube for feeding. Problem is the patient keeps pulling the tube out. English statute allows us to restrain her to replace the tube and feed her but we are looking for an effective restraint method. With a normal patient we would use a "crucifix" restaint, laying her flat and staff would hold her arms out and still. Similarly someone would hold her legs together. However, lying flat would be dangerous when inserting an NG tube. Anyone experienced this. Can they suggest a safe method of restraint whilst the patient is sitting upright or at least at 45 degrees. Even though this lady is very frail she is amazingly strong.

[nightmare]

If you are allowed to use the "crucifix" method can't you modify it for 45 degrees? You could still restrain legs and one arm,the problem would be how to restrain the other arm without getting in the way of the person replacing the NG tube.Perhaps if you pulled the bed away from the wall and the member of staff stood behind the bed they would be able to restrain from there without impending the process of replacing the tube.

[ERRNTraveler]

You could try a belt restraint- it goes around her waist, and then her hands are restrained to the belt.

[TrudyRN]

LOL, at first glance, I thought you wanted to use the NG tube to restrain her. :hatparty::hatparty::rol l :hatparty:

[Altra]

What about using a chemical restraint - sedation - for NG insertion?

Soft wrist restraints should be effective after that.

Sounds like a sad case - hope she gets well enough physically to begin the psychological healing process..

[birdrecruit]

Thanks for all your replies - they are really helpful. We use a certain amount of sedation but we have to be careful about respiratory failure. We feel a bit unhappy about using material restraints but I can see where you are coming from. I think its going to have to be crucifix at 45 degrees, although keeping her head still is still going to be very difficult. I'll put it to the team.

[lsyorke]

Is this patient alert? And if they are have they consented to having an NGT passed?

[birdrecruit]

Originally Posted by lsyorke

Is this patient alert? And if they are have they consented to having an NGT passed?

They havent consented. They are on Section 3 of the Mental Health Act.

[woody62]

Originally Posted by birdrecruit

They havent consented. They are on Section 3 of the Mental Health Act.

I had to have an NG tube passed last July. It was one of the most unpleasant things I have ever experienced. No longer will I ever tell a patient to just swallow. It felt like someone was trying to shove a garden hose down my throat. I had it in place for 21 days and I wouldn't have pulled it out on a bet. Is she pulling it out because it is too uncomfortable in place? Or because she doesn't want the tube feedings? I remember how unfortunable mine felt and that could be a reason. But I do not think so.

Woody

[sharrie]

Originally Posted by woody62

I had to have an NG tube passed last July. It was one of the most unpleasant things I have ever experienced. No longer will I ever tell a patient to just swallow. It felt like someone was trying to shove a garden hose down my throat. I had it in place for 21 days and I wouldn't have pulled it out on a bet. Is she pulling it out because it is too uncomfortable in place? Or because she doesn't want the tube feedings? I remember how unfortunable mine felt and that could be a reason. But I do not think so.

Woody

Reading the OP this lady is anorexic and under the mental health act which in the UK means that they are allowed to perform interventions in her best interest even without consent. I imagine she is pulling the tube because she is trying to refuse treatment