Elbow Restraints for In Home Use

[AliceKay]

Hi there:

I am extremely upset right now! I am 12 weeks away from graduating from my PN program and have just completed 3 months of Peds clinical rounds. A very good friend of mine has a 5 year old child with CP. He was a 24.5 week preemie, is (of course) wheelchair bound, requires a trach, is completely deaf (without his cochlear implant), and is nearly blind. He has severe developmental delay and is non verbal.

Recently, this child has begun playing the game of "Pull out the trach", because he knows it will ALWAYS get somebody to come running. He thinks it's HILARIOUS, at first. A couple of days ago his mother had a very difficult time getting his trach back in and she and Patton were both traumatized by the experience, as you can well imagine. This, of course, did not correct his behavior. She posted something about it on facebook, and I suggested that she ask her doctor about elbow restraints. Note the fact that I said "ask your doctor" and not "go out and buy them". The thing that has me so ticked off is that another friend of hers, with zero experience with special needs children, and zero medical training thinks that the internet has all of the answers and is telling my friend that the internet says that elbow restraints are a no no. My response to that was that pulling a trach out is a BIGGER no no and that if used, intermittently (under a doctors supervision), it could prove to make life much safer for Patton and much saner for his parents. Not a cure all forever.. but, just until he gets past this phase that he's going through, and just for part of the day.

Is there anybody here with an actual license who disagrees with me? If I am wrong I would really like to know, and understand the rationale behind it. Thanks so much, and sorry for being so long winded. I love this child and, simply, want to help him and his family. :heartbeat

[roser13, ASN, RN]

I hate to say this, but I think that this situation is beyond your control and outside the realm of your influence.

It doesn't really matter whether any of us agree with you or not. It only matters what mom and/or dad feel is the issue and whether they are willing to pursue the current problems with the medical professionals who are actually involved with the case.

[FLArn]

Please tell me that Patton is a name you made up for the post. Please be aware the a real name along with as much info as is in this post given about a patient in your care will be enough to cost you a job at the very least. It is not too soon to begin to be aware of professional boundaries. Mom and Dad can post whatever info they want but we must always safeguard our patients' identities.

[neuroms]

I think you're correct thinking that the behavior needs to blocked for a time. You're also correct referring your friend to her pediatrician for this discussion, unlike the the responder who KNOWS that it's not appropriate. It's not within the purview of either of you to decide whether restraints would be appropriate. The difference is you know that, and that's why you should be trusted.

[AliceKay]

FLArn: Patton is not a patient of mine and never has been. He is the child of a dear friend. There has never been, and never will be a professional relationship.

[AliceKay]

roser13: I do understand that it is not within my control. But, as a nurse, it wouldn't really be in my control anyway. All I can do is simply suggest and advise that they speak to their physician, correct? I simply wanted to know if there was any sort of safety issue, in a situation such as this and if my rationale was correct or not. :)

[AliceKay]

Patton is not a patient of mine and never has been. He is the child of a dear friend. There has never been, and never will be a professional relationship.

[AliceKay]

I hate to say this, but I think that this situation is beyond your control and outside the realm of your influence.

It doesn't really matter whether any of us agree with you or not. It only matters what mom and/or dad feel is the issue and whether they are willing to pursue the current problems with the medical professionals who are actually involved with the case.

I do understand that it is not within my control. But, as a nurse, it wouldn't really be in my control anyway. All I can do is simply suggest and advise that they speak to their physician, correct? I simply wanted to know if there was any sort of safety issue, in a situation such as this and if my rationale was correct or not.

[roser13, ASN, RN]

FLArn: Patton is not a patient of mine and never has been. He is the child of a dear friend. There has never been, and never will be a professional relationship.

Whether or not a professional relationship exists, it is unwise to post actual names in an online forum. Legally, it is not your choice to expose a child's name and circumstances on an internet forum.

[evolvingrn, BSN, RN]

I agree with you but about the elbow restraints but try not to take it so personally that someone disagreed with you. it's not a personal attack on you....kwim? Special needs parenting is a hard road to manevuer . ....I always joke that i have made some of my best friends and my worst enemies within that circle of aquaintances. I have a child with special needs which is the ONLY reason i offer thoughts at all but i get eaten alive at times too.....especially on an online forum where there is annonomity. just shake it off , roll your eyes, let them express their opionion and move on...and continue to support your friend the best you can.

[JenniferSews]

Some people just LOVE to sound like an expert. And you're right, they use the internet to do so even when they don't understand what they are talking about. I don't know a thing about the situation or elbow restraints personally. But as a mother if I can go to the bathroom or shower without worrying that my child will pull his trach out while I'm in there, I would ask my doctor about it. You're probably right it's a phase that he will go through. I would personally delete my facebook post though and discuss it with the mom personally. Then you take the know it alls out of the equation.

[P_RN, ADN, RN]

The only suggestion I would have is to ask to go with Mama to the pediatrician and ask her to bring up the subject of the kiddo pulling the trach. He's blind and deaf? so tactile is about all the child has left. How long will he have the trach?