Do all of your vented pt's get restrained?

[JHUBRAIN]

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

[NZArkieRN]

All ventilated patients in my unit, are restrained with soft wrist restraints! It doesn't matter how alert and oriented they seem to be, you never know when they might panic, and pull out their tubes. It is like a reflex action. They can't help it. It is just not worth taking the risk.

[ICUmanager]

We restrain our vented patients about 80% of the time. I've seen many vented patients that can tolerate the ETT without a bunch of sedation and/or restraints. However, we often restrain during periods of sleeping or sedation due to the patient possibly grabbing at the tube while not in wakeful state. We've also had patients that are unrestrained most of the time and then request restraints when they know that they may need them. I've also unrestrained several patients that didn't require them without self extubations. As others have mentioned the self extubations I see are on those who are IN restraints.

[cardiacRN2006, ADN, RN]

I've had 2 self-extubations---and they were both restrained patients. One tongued it out and the other scooted himself way, way down in bed and pulled it out with his restrained hand.

We restrain maybe 50% of the time. My patient's are nicely sedated or have impaired brain function. These guys aren't moving.

The lightly sedated and sedation vacations are definitely restrained.

[*LadyNurse*]

It used to be very routine for our vented patients to be restrained, but here lately we've had a few "CMS events" e.g patient deaths while in restraints (although the restraints had nothing to do with the death).

Our facility is trying to move from physical restraints...

I have found myself physically trying to hold patient's down so they wouldn't self extubate! Its crazy!

We even had the pleasure of being inserviced and watching a video for "alternatives to restraints".

That is fine and dandy...but I'm not about to have my barely sedated b/c of low BP fresh OPEN AAA repair try to play with the "activity apron"...:no:whatever.

[Christie RN2006]

Most of our vented patients are restrained. We used to be able to restrain patients under our intubation protocol, but when JCAHO came around this last time, they told us that we were no longer allowed to do that. Now all of our restrained patients have to have a signed order every day. A lot of times we don't restrain the patients that are heavily sedated (paralytics, etc), fully A&O patients that I know will be ok, or our neuro patients that are totally unresponsive. If the patient moves much or they are lightly sedated, you had better believe they are going to get restrained. I have had patients extubate themselves and had to get reintubated. It is a lot of paperwork for self extubations, not to mention the trauma that it can cause the vocal chords!