physical restraint in picu

Looks like I'm takin the bus to Ohio too!!

We, unfortunately, are not always 1:1 on intubated pts. We use soft wrist restraints/no nos/swaddling whatever works safely for the pt. Never do we rely on a parent! We use fentanyl and versed drips on all intubated kiddos- then go to Propofol the day before extubation. We do use alot of Vec/Nimbex also. And I have become a big fan of Chloral! All in all, I think we do a pretty good job at keeping our kids comfy and safe.
We use a sedation/vent comfort scale although I could not tell you what it is called. And really, it seems to be something we just fill out- I can't say that I have ever said "oh the kid scored suchand such so let me adjust my sedation". Really, I don't even think most people fill it out.

Good grief, no way! We've got 5-10 more inches of our own crap coming tonight, just in time for my weekend commute!


I am so tired of snow!

I hear ya sister! Today is the first day it DIDN'T snow since I can't remember when. But there's more in the forecast, including some freezing rain. That ought to make the commute to work a real treat, since I haven't even seen a plough yet this winter.

But back to restraints in the PICU. It would be very nice if anaesthesia brought the kids back in a state that would allow us to get them completely admitted before they tried to sit up.

It would be even better if after I spend 2 hours pleading with our docs to give me extra sedation for my poor little intubated baby if the crazy mom would not come in the room, get in the baby's face, and holler "are you gonna wake up for mummum...come on, open those eyes!"

I'm totally there with you kessadawn! And they still don't get it even after it's been explained to them why the kid shouldn't wake up. Makes me crazy.

Hi there!
I my experience, we use both sedation/pain scores (RASS,FLACC,FACES) to assess the adequacy of our sedation/pain management. We also require any means of restraint (soft wrist, Welcome sleeves) to be discussed and reordered every 24 hours. We also document the location, perfusion, skin integrity of the extremities restrained q2hrs.
Personally, if I have reliable parents, I will let them hold little hands and give them a break if I can. Drugs are great, but let's face it- these kids who are intubated for weeks at a time go through them like elephants. Pretty soon, we have kids on versed, fentanyl, dex, ketamine gtts along with hourly boluses of pentobard and the occasional ativan. So, what are we to do to keep our patients safe? Restraints are an ineviatable intervention, necessary, yet difficult.
One last thing, remember kids are easily distractable- so if the tolerate any kind of stimulation, soft music or familiar movies/TV shows. Good luck!