Had to do my first terminal wean...

[NickiLaughs, ADN, BSN, RN]

Hi all!

I'm a surviving new grad in the ICU (what else can you really do but survive those first 6 months?). Just wanted to say that I had to do my first terminal wean yesterday per family's request/ Dr's orders. It was tough. I had taken care of the patient for three nights straight and he'd improved my first night, but then the second night I came back, and the drips started going up (3 pressors all maxed out) and the last night, he had two IV poles for all his drips. It was sad because he had initially been improving but by the time I had taken him over he had already been on the downhill path (reintubation, etc).

I just find the hardest thing is dealing with the family. They're devastated, the decision is tough, and I have no idea what to say. I just would ask them about little things, if they would like coffee, tissues, offered a blanket for the patient since he was so cold, pain medication for the patient if they thought it would help.

I guess we never learn what is the right thing to say is, but if anyone has any suggestions I'd appreciate it. I feel that saying "i'm so sorry for your loss" is so generic when every medical staff member says it. I know "it was an honor to care for your family member" is a little better. I'm sure they believed that I was genuine because I kept tearing up, but obviously my focus is on the patient, the family and attempting to keep an eye on my other pt.

Thanks for any advice.

[dorimar, BSN, RN]

gees louise,

it never gets easy and there is never "the right thing to say". I believe the families know when you really care. Allowing them time with their family member, and offering the little things like kleenex and water does help. As hard as this part is, and even though it ends this way... Sometimes these are the times when we make the most difference...

I really believe that.

[detroitdano]

I had my first terminal wean a few weeks back too. It was sad because I admitted him unstable, watched him become stable, then he just went back downhill over the course of a few weeks. When RT extubated him he was even able to talk. He only made it about 15 minutes on nasal cannula before he passed. The family knew me well and I didn't have to say much, gave the wife a hug and she said thanks for everything. I feel it's rather obvious just by the comfort level in conversation with a family when you don't have to wonder if they know you do care.

Terminal weans are part of our day to day process, but it's so much harder when you know they're still "with it." I helped a nurse with a terminal wean early in my orientation and the patient was braindead. You know they will never improve and it's easier to accept their passing. When they can still look their family in the eye and talk it's an entirely different scenario.