BiPAP and Restraints

[MunoRN, RN]

An ongoing feud where I work has been the issue of restraining patients on a BiPAP. Both sides agree that ideally patients on BiPAP are never restrained due to the high risk of aspiration should they vomit. Making that a reality is a very different thing since we'd essentially need sitters for most of our BiPAP patients. An argument could be made that we need to just let these people take off their BiPAPs and let the chips fall where they may, but that's a different topic.

A quick look through guidelines and standards doesn't produce anything on this issue and without that, making the case for exponentially more sitters is near impossible. If anyone knows of standards regarding this that would be helpful. And if your facility has a policy not to restrain BiPAP patients I'm curious how that works.

[Creamsoda, ASN, RN]

Our policy is if they are on bipap and are unable to take it off on their own either due to weakness, confusion, somnolence, they have a sitter. So it would be assumed if they were restrained they would have a sitter as well because they would not be able to take it off...(or may not need the restraints if they had a sitter...unless they were ETOH withdrawing/combative or soemthing).

If you have a patient that is dependant on that bipap and they keep taking it off you better have a sitter. Just restraining them with no one watching them would almost certainly lead to a sentinal event.

[MunoRN, RN]

CreamSoda, I'm curious if you use sitters for patient's who aren't restrained but are unable to remove their own BiPAP? How many sitters would you guess your facility uses on a given day?

[nurseprnRN, BSN, RN]

I don't think it would matter. If you have accepted members of that population, you have to make provisions for appropriate safe care and monitoring.

[MunoRN, RN]

I'm all for that but I need to make the case for increasing our sitter use exponentially if we're essentially going to have a sitter for just about every BiPAP patient. Are there any actual Standards advocated by a professional practice organization that support such a request?

[blondy2061h, MSN, RN]

We don't restrain people on bipap as a general guideline. If they're confused, the get a sitter. If they're not confused and keep taking the mask off, it's a refusal. We have found two things that are helpful in helping people stay on bipap. One is mild sedation. A low dose fentanyl drip plus some PRN Ativan or something like that. Another is timed breaks, ie, 3 hours on, 1 hour off. During the hour off they can wet their mouth, talk to family, and ambulate with other oxygen to whatever degree they can. When they get restless, we encourage them when their next break is.

[sapphire18]

Ive never heard of any standards for not restraining patients on BiPAP. Wherever I've worked, they've been restrained if the situation warranted. This was also in ICUs, though...you basically have at least one person within eyeshot (is that a word?) of every patient at all times.

[blondy2061h, MSN, RN]

Ive never heard of any standards for not restraining patients on BiPAP. Wherever I've worked, they've been restrained if the situation warranted. This was also in ICUs, though...you basically have at least one person within eyeshot (is that a word?) of every patient at all times.

Again, not a hard and fast rule, but we try and avoid restraints as much as possible. A lot of data shows increased mortality with restraints (though I know that correlation does not imply causation and patients that need to be restrained may be more critically ill to begin with).

[nrsang97, BSN, RN]

We do not restrain when a patient is on bipap. They have a sitter if they need one.