Alcohol Withdrawal & CIWA

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  1. Do you use the CIWA tool in your practice?

    • 0
      I have never heard of this tool.
    • 0
      No, I have never used it.
    • 0
      No, I don't use it anymore.
    • 4
      Yes, I use it from time to time.
    • 8
      Yes, I use it frequently.

12 members have participated

Hi, I'm a nursing student doing a learning plan on alcohol withdrawal syndrome and use of the CIWA tool. I would like to gather some anecdotes and opinions about the CIWA tool from nurses who have had experience using it, or experience with patients dealing with alcohol withdrawal in general.

Some questions to consider:

  1. Is the CIWA tool part of your institution's policies? Is it used on a regular basis?
  2. What do you find are the advantages and disadvantages of using it?
  3. Do you find it useful in general?
  4. Is it difficult to breach the topic of alcoholism with alcohol withdrawal patients? What are some of your strategies?
  5. Do you have any stories regarding patients with alcohol withdrawal syndrome, or more severe cases like withdrawal seizures and delirium tremens? Please share!

I'd really love to hear all your stories! Thanks in advance for helping me out! :)

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It's a waste of time.

Just dose them with the Ativan and Valium when you think they need it. Some regulars will even tell us when they want it

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Specializes in ED, psych.

We use the CIWA, and while I think it's helpful for those patients in the very beginning of alcohol detox ... some patients can certainly manipulate the tool.

I typically assess for tremors, for example, when the patient doesn't realize I'm assessing (i.e. while conversing about something else). Quite often, I'll ask questions and receive the standard responses "I can't stop shaking," (as they start shaking their limbs like mad ... however, they weren't shaking 5 minutes ago), "I'm feeling like things are crawling all over me." I can assess shaking and sweating, but not the creepie crawlies -- I take their word for it. Many patients are honest; some are not and just want their Ativan (some at higher and higher doses).

Some patients are receptive to alcoholism/alcohol withdrawal. I've had a few patients try over and over again -- these frequent fliers are hard to watch (and sadly, several are vets). Some aren't, and blame something else. Depends on the patient.

Alcoholism is a terrible disease. The CIWA is just a tool, but it doesn't take the place of compassion and nursing judgment.

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We use CIWAs on our patients. I never come out and say I'm doing a CIWA, they can be done by talking to the patient and interacting with them without coming straight out and saying "are you having tactile disturbances?", etc.

As fiona59 stated, the regulars know when they need medicated. We use the CIWAs primarily to gauge whether the patient needs moved to ICU vs the floor, but honestly that can be done without the use of CIWAs. You know when they need the more one-on-one.

Most of the patients we get who abuse alcohol are very open and honest about it (I say this based on asking family about their alcohol use and comparing it to what the patient tells us). Well, I should say the men are more honest. We have a few older women (60s-80s) who are chronic etoh users and frequently in for overdoses/alcohol intox and they will deny it until they turn blue...or until the bac comes back. The men are seemingly very open about their etoh use. Kind of interesting now that I think about it...

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Specializes in Med-Tele; ED; ICU.

CIWA has its place insofar as it gives me something concrete to chart as I start administering doses of Valium and phenobarbital that would take down an elephant.

It's somewhat better than the near-useless 1-10 pain scale in that it has some objective measures but is still often manipulated by people looking for something.

I often don't bother broaching the subject of alcoholism with patients. Most of 'em know everything I could say. Occasionally, with a very young person, I will go so far as to say, "Do you know the definition of an alcohol problem? When it adversely affects your life. Like waking up in the ED, restrained for safety, and smelling of your own urine."

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Thanks for all the insightful answers! I figured from looking at the tool that it really is just that - a tool. Clinical judgement seems by far more important in these circumstances from what I've been hearing. As a fresh student, the tool is helpful for me mostly because I don't have a lot of exposure to these patients yet.

Regarding what smf0903 said, I'm intrigued by the fact that men seem to be more upfront about alcoholism than women. Is this something that others find true as well? I wonder if this has to do with gender roles/stereotyping, in that men may feel less judgement compared to women based on societal views about alcoholism, thus making it more likely for them to divulge the information freely.. or maybe it is more complicated than that. Would love to hear your opinions.

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We use it for alcohol withdrawal. I like the fact that we use an order set with all the medications (MVI, Thiamine, Librium, Haldol etc) and Ativan per CIWA. Some patients do request the Ativan and will manipulate the scale. It an be helpful when giving the higher doses, to ensure reassessment and to able to communicate to physicians.

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Specializes in Critical Care.

My institution recently started using GMAWS. It's shorter, sneakier (in that it relies a little bit more on objective rather than subjective data) and in my opinion somewhat less vulnerable to manipulation than CIWA.

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Great questions. So the drug in most protocols used is lorazepam iv push 1 - 2 mg sometimes as frequently as every 30 minutes. Lorazepam has a short half life, it's also a benzodiazepine which in high doses can be dangerous causing respiratory depression. One thing you should read about is a medical called phenobarbital, it's a class of drug known as a barbiturate and originally manufactured as an anti convulsant. It is longer acting and allows for minimal dosing of lorazapm to suppress the dangerous effects of alcohol withdraw. It is administered IM or po.

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Specializes in Med-Tele; ED; ICU.
phenobarbital, it's a class of drug known as a barbiturate and originally manufactured as an anti convulsant. It is longer acting and allows for minimal dosing of lorazapm to suppress the dangerous effects of alcohol withdraw. It is administered IM or po.

Or IV...

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