"I want to go for a walk and a shower," "will you unhook me?"
Do you stop the IV infusion to allow the patient some freedom?
Times where it really bothers me:
-Patients who are on PCA's who want to go out to smoke (which we have sign a consent for leaving the building).
-Patients who need an IV abx and will have treatment delayed until they are ready.
-Those who have peripheral IV's which end up infiltrating, leaking or falling out which adds more time to my day because I have to put in another IV, which then delays more treatment.
-I am stopping an infusion which is a doctors order
-I have to get back into the room asap to restart the infusion (PCA's, ABX) because going for a smoke puts the patient in a pain crisis and then suddenly they need their PCA again.
(by the way, we do give nicotine patches for those who smoke, and we have them sign a consent when they leave the floor)
Our policy is no, more because of the infection risk than the inconvenience. However, on my unit it is rare to have a patient that can get out of bed, so I really don't face this on a regular basis...
Abx ... no - better to talk about this with the patient that is obviously a walkie-talkie and work out ahead of time that, "at x time you need your dose of Med A ... and during that hour you'll need to be in bed or in a chair in your room."
Since my patients aren't mobile, it's not a prob for me. I know as a patient once I was allowed to walk around with my antibiotics running. I just wheeled the pole around the floor with me.
If a competent patient insists an infusion be stopped don't know what choice you have. They can refuse a treatment, at least in this country. Of course it has to be an informed refusal which means you have to discuss the consequences of stopping the infusion with them.
for smokers i am not sure that forcible discharge is necessary....we have them sign a release of responsibility and the doctors sign orders for 'continuous' pass but if they are a & O x3 we do not force the issue to much. The guy i saw on the street smoking also left our facility daily to go to dairy queen or where ever, lol he would carry his giant foley bag on his arm in public.....lol, i was like somebody get that pt a leg bag stat. all smokers receive an order for nicotine patches when they are admitted. We do acute symptom mgt so people only stay 3 to 5 days on average and this is usally not an issue, for this guy it was very important to live the little of his life left to the fullest so we tried to work with that and we just made sure the doctors wrote the orders to cover what they were okaying.
Specializes in PCU, Stepdown ICU, Home Health Case Management, ED.
we were informed that because our facility is non smoking, anyone wishing to go outside to smoke will have security called on them if they insist on doing so.
My unit has a lot of independent pts who stay at the hospital for a LONG time, so we'll often med-lock them in between antibiotic infusions, for personal care, walking the halls with PT, etc. It helps them maintain some sense of normalcy in their lives. I usually give my patients a schedule for the day, so they know when they're getting what and can plan in between. I won't interrupt treatment (abx, fluid bolus, etc.) for a shower, but if it's just KVO fluids I will. I haven't had anyone ask to be unlocked so they can go smoke, but we're a non-smoking campus, so they would have to leave AMA.
If you are well enough to have your IV disconnected to go for a walk/smoke, then you can go home.
Not everyone requires a continuous infusion of IV fluids. Walking is HEALTHY for patients who are able to do so and it should be encouraged. Smoking, notsomuch.
Today, my tech called me to see if she could stop the infusion to help get a patient to the bathroom. I thought of what some of you said in this thread and said, "no, because it increases the chance of infection," but I offered to come help her get the patient to the bathroom.
I told my preceptor I didn't allow the tech to unhook the fluid for toileting and she lectured me saying she allows patients to be unhooked for the bathroom. She said, "while unhooking increases the risk for infection, not unhooking increases the risk for falls."
p.s. The next time the patient needed to go to the bathroom the tech phoned my preceptor instead of me and the infusion was stopped
If you are well enough to have your IV disconnected to go for a walk/smoke, then you can go home.
I must disagree with this. All patients should be walking (if feasible), especially post op pts. I don't think it's fair to pts to say that if you can go for a walk without your NS then you can go home.
My view on this:
IV antibiotics--they can wait 30 or 60 minutes until the infusion in complete
Heparin or some other type of other continuous gtt--no, must stay running
PCA--can we even let them go outside with the PCA drugs?
Fluids--for they most part, they can go without them
all smokers receive an order for nicotine patches when they are admitted. We do acute symptom mgt so people only stay 3 to 5 days on average and this is usally not an issue, for this guy it was very important to live the little of his life left to the fullest so we tried to work with that and we just made sure the doctors wrote the orders to cover what they were okaying.
ObtundedRN, BSN, RN
428 Posts
Our policy is no, more because of the infection risk than the inconvenience. However, on my unit it is rare to have a patient that can get out of bed, so I really don't face this on a regular basis...