Do all of your vented pt's get restrained?

RN't-I-Cute · Sep 24, 2004

At the hospital where I work, 99% of our intubated patients are restrained. The only difference among these patients is what kind of sedation they're on, unless of course they're a Neuro patient for which they're on no sedation. I used to a believer in restraining intubated patients only on a case-by-case basis. But of course a patient had to come and make me change my beliefs. It was a young guy (in his 20's) who came in for an abcessed tooth that ended up infecting his sinuses. Anyway, the guy was totally with it. Perfectly understood he was not to touch his tube. But then he fell asleep and I guess when he woke up, he forgot he had a tube down his throat. Needless to say, he self-extubated. From then on, everyone gets tied down unless extubation is planned for the very near future.

bluesky, BSN, RN · Oct 1, 2004

So far, only about 30% of my pts have been physically restrained. Most fresh post-ops are on Propofol, but we try to wean ASAP. Many are so sick that they just don't have the strength to grab, anyway. I really don't like to restrain my pts. They are already completely disempowered enough as it is...

bluesky, BSN, RN · Oct 5, 2004

My hospital changed it's policy just about a year ago. I was talking to one of my mentors about this. She told me that in fact much fewer (more like 10%) of our vented pts get restrained. She said that there have been just a few self-extubators and that they have either tolerated the extubation or been immediately re-intubated with no sequellae. On the other hand, I work at a huge teaching hospital with many residents nearby for stat re-intubations. I can see where that would be a problem at a smaller hospital with fewer resources.

Critical care rn · Oct 5, 2004

We do not restrain all patients on vents. Many are restrained, probably about 70%. Others with dec LOC, or those chronic COPD's that just about suction themselves... don't need to be. JCAHO was happy about that. We have a line/tube protocol to follow when we want to restrain. We are supposed to notify the administrator if we do restrain...what a joke!:) Like we can't make our own decisions....another example of micromanagement!

JHUBRAIN said:
Hello all - I was just sitting in a meeting and the question came up about restraints and pt's on vents. One person said that all pt's in the ICU setting on a vent were to be placed into restraints, while another one said it depends on the pt's themselves (i.e. brain function, etc). How about your place? What do you folks do? Also, does anyone know if a protocol has made made addressing this issue (I know that is a very touchy subject with JCHO). Thanks very any help and God Bless you all - Gary

minifish · Oct 8, 2004

Well you guys in the USA are lucky, in the UK restraints are never used. well not that I have ever seen and boy could we do with them sometimes. Especially the weaning patients who are thrashing about and you basically have to sit on them to stop them extubating themselves. I think it would be interesting to see how many self-extubations would be prevented if restraints were used in the uk.

Just my thoughts.

Jxx

dazzle256 · Oct 8, 2004

minifish said:
Well you guys in the USA are lucky, in the UK restraints are never used. well not that I have ever seen and boy could we do with them sometimes. Especially the weaning patients who are thrashing about and you basically have to sit on them to stop them extubating themselves. I think it would be interesting to see how many self-extubations would be prevented if restraints were used in the uk.
Just my thoughts.
Jxx

Sitting on a patient is a form of restraint :)..

louloubell1 · Oct 8, 2004

bluesky said:
My hospital changed it's policy just about a year ago. I was talking to one of my mentors about this. She told me that in fact much fewer (more like 10%) of our vented pts get restrained. She said that there have been just a few self-extubators and that they have either tolerated the extubation or been immediately re-intubated with no sequellae. On the other hand, I work at a huge teaching hospital with many residents nearby for stat re-intubations. I can see where that would be a problem at a smaller hospital with fewer resources.

A few self-extubations is a few too many if you ask me. Any one of them can go horribly bad, and quickly too. Having trained people nearby to reintubate is just one factor, bluesky. Self-extubation can cause larygeal edema (making it difficult or impossible to reintubate) and it can cause permanent damage to the vocal cords. These facts and the respiratory distress that will ensue after self-extubation will be on your shoulders if you are that patient's RN.

I typically do not restrain a patient who is tubed and yet alert and cooperative, but I tell them flat what could happen to them if they pull that tube out, and the second I see any behavior that looks to me like a bout of tube pulling is about to begin, I have no problem using soft bilat wrist restraints. Even when a patient is cooperative and not messing with the ETT, it makes me so nervous all night long to know that they are not restrained. All it takes is for you to get burned once when a patient yanks that tube out and horrible problems ensue, and you feel that way I guess. Empowerment is all nice and everything, but helping the patient actually live through his or her ICU stay is a the top of the priority pile.

minifish · Oct 11, 2004

dazzle256 said:
Sitting on a patient is a form of restraint ?

Well depends on your definition of restraint

pghfoxfan · Oct 11, 2004

minifish said:
Well depends on your definition of restraint

We had a standing rule that all intubated patients were restrained. IMO, not everyone needs restrained.

Danianne · Mar 22, 2005

When I was intubated I was restrained and under alot of sedation but I totally remeber having my arms unavailable to me and that I guess agitated me. so they let one arm go at a time and finally let me be free. BUt then they were turning me and the tube got caught and I was "accidentally" extubated. ARGHHH! :crying2: so in a way being tied down is good but it can be not so fun too esp when your nose is itchy and the nurse thinks that you are trying to pull yer tubes but all you are trying to do is scratch

Lorus · Mar 22, 2005

All of our patients automatically get put on the 'invasive device protocol' if they are tubed. This covers us in the use of any sedation/restraints that are required until they are extubated. Basically its up to the RN to decide if the pt. can safely be unrestrained.

Its amazing how sometimes no matter what you do, (short of paralyzing a pt) some folks will still find a way to extubate themselves. Recently I had a patient that was sedated and wearing bilat soft wrist restraints self-extubate. He was calm and resting quietly -hadn't so much as twitched all shift... I was literally walking out of the room when the vent and monitors went nuts. When i turned around, he was laying there with that 'deer in the headlights' look, and the tube was hanging out of his mouth still attached to the bite-block. (He was still restrained, so im not sure if he 'tongued' it out or used his knees or something, but he managed to pull it somehow) He was ok with a FM at 10L for a bit, but eventually needed to be re-tubed.

LindaMarie76 · Mar 23, 2005

At my institution we definitely use restraints. These include: soft wrists, posey vests, and mittens. No - we don't use all three of them at the same time ?

We are a 550 bed community hospital and at night, if a patient self-extubates, we are SOL unless the ER doc or lead RT can re-intubate. We don't have residents roaming our halls. Personally, I don't feel all patients need to be restrained, especially if the diprivan or ativan gtts are effective. If a patient is wide awake on 50 mcgs of Diprivan and not used to being intubated, I make sure that their arms are tied; however, I'll untie them whenever I am in the room or in front of them. I'll encourage them to stretch, scratch their nose, wipe their eyes, write messages, etc., with the understanding that they'll be retied when I leave the room.

"We have your hands restrained because you are not used to having something down your throat. Although I trust you not the pull out the tube, if you fall asleep and suddenly wake up, your first instinct is going to remove the foreign object in your throat. Therefore, this is strictly a protective measure for your benefit."

A level of trust is developed and the patient rests easier knowing that I'll be in frequently to allow them to use their arms.

Linda

Lorus said:
All of our patients automatically get put on the 'invasive device protocol' if they are tubed. This covers us in the use of any sedation/restraints that are required until they are extubated. Basically its up to the RN to decide if the pt. can safely be unrestrained.
Its amazing how sometimes no matter what you do, (short of paralyzing a pt) some folks will still find a way to extubate themselves. Recently I had a patient that was sedated and wearing bilat soft wrist restraints self-extubate. He was calm and resting quietly -hadn't so much as twitched all shift... I was literally walking out of the room when the vent and monitors went nuts. When i turned around, he was laying there with that 'deer in the headlights' look, and the tube was hanging out of his mouth still attached to the bite-block. (He was still restrained, so im not sure if he 'tongued' it out or used his knees or something, but he managed to pull it somehow) He was ok with a FM at 10L for a bit, but eventually needed to be re-tubed.