chemical and physical restraints in vent patients

[MrsWampthang, BSN, RN]

I'm just wondering what policies other facilities have for restraints, both physical and chemical. For months now, our facility has been preaching that they want to go restraint free. One of the patient population we have are vent patients, and sometimes those vent patients are so wild, in addition to trying to pull thier trachs or ETs out, they also try to sit up and get out of bed so we are constantly at their bedside putting them back in bed, etc. (this is with versed going at high rates, and bilateral wrist restraints). The only alternative I can see is if the facility breaks down and hirers sitters, otherwise, I can't see doing away with restraints completely. What are other facilities doing and what are the policies there? And are any other facilities having issues with families not wanting their wild, very strong, family members restrained and sedated, yet not wanting to sit with the patient themselves? I guess this post is jumbled but I hope it makes enough sense that I can get some feedback. I'm feeling a little frustrated from dealing with wild vent patients and constantly being griped at by family members for "knocking their loved one out," or having to almost literally sit on a patient constantly to keep him from sitting up and pulling his trach out.

Thanks,

Pam

[Creamsoda, ASN, RN]

You would think they would make an exception for vented or icu patients. Thats just plain rediculous. The restraints are for the patients own saftey. We usually have our patients restraied because most or alot are on some form of sedation so they are not totally with it and become confused very easily. Talk to your unit manager about the issue.

Cher

[AuntieRN]

We use both chemical and physical restraints for our vent pts...then once they are off the vents we use them very sparingly if ever.

[Blee O'Myacin, BSN, RN]

How I wish that a sedation and analagesia protocol would be standard of care across the board for all vented patients. (With the exception of chronic vented patients) - I know that I wouldn't like to be tied down, completely awake with tubes coming in and out of everywhere not knowing how I got there or what's wrong with me, only able to see whats above my head... you'd bet I'd be trying to climb out of bed!! (Even if I shouldn't or couldn't)

I think that education is key for everyone involved, from families to the administration who arbitrarily decide to go "restraint free" to the docs who decide that they want to withhold "all sedation" for 24 hours prior to a weaning trial.

Good luck. I find this situation is like spitting into the wind.

Blee

[Rnandsoccermom]

One of the hardest things to deal with in critically and chronically ill pt's is their mentation as related to their illness. There are times when some sort of restraint is necessary whether anyone likes it or not.

How do you as an RN protect yourself? Tubes stay in or get sued when they crack their head open when they hit the floor? We have a family suing our facility for that in particular. Documentation is the ONLY way to help you in that situation.

Quick story: In our SCU one of the pysicians refused to sedated a patient who had been trying to crawl OOB and slipping through the siderails. He had already fallen out twice, tubes and all. The RN was very busy that day and asked him again for a sedation order, he refused. She then proceeded to tell him the next time the patient came out of the bed she was going to call him to come and help her pick him up and that she would chart his response. She got her order. And after a couple of days he didn't need it anymore.

Docs and families also need reminding about what getting woken up every hour or two for 24 hours a day does to you. I have no problem asking them how they would feel if it were them.

[TazziRN, RN]

We have a protocol, several of them. The weakest restraint is chemical sedation (Ativan, etc.) with soft wrist restraints. The hardest is a Diprovan drip, with several levels of sedation in between. Which one is ordered for the pt depends on the pt.

[nuangel1, BSN, RN]

i worked icu for 12 yrs while we did not have formal protocols like tazz .we did use chemical restraint along with wrist restraints for vented pt .each pt had a different sedation regime ie morphine ,fentanyl ,versed ,ativan ,etc we used different meds depending on what worked for the pt .some pts required haldol or respiridol too.while the goal was different for each pt ie some pts do ok somewhat sedate and vented others need to be more deeply sedated .if we were weaning the pt then they had to be awake enough to participate so to speak .ARDS pts are the toughest because they often require deep sedation and paralytic.as long as an ett was in the pt had soft restraints on .