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Physical Restraint in Intensive care unit

Posted
samer2014 samer2014 (New) New

Hi all .

i am looking for success stories and ideas for reducing restraint in ICU . i need something new. innovative interventions .

Any ideas would be highly appreciated .

looking forward to hearing from you

sallyrnrrt, ADN, RN

Specializes in critical care, ER,ICU, CVSURG, CCU.

Relatively fresh post cabs, prematurely extraterrestrial self with out them (I would also ;0

same patient pulls out art line and foley without them,

and now some facilities consider side rails restraint, and in LTC, valid point, but in icu,

same me patient falls out of bed, loosing a chest tube, thank goodness he did not have ballon pump

i don't mean to be so sarcastic, There are some necessities, I hate restraints, but sometime it truly is pt safety

Relatively fresh post cabs, prematurely extraterrestrial self with out them (I would also ;0

same patient pulls out art line and foley without them,

and now some facilities consider side rails restraint, and in LTC, valid point, but in icu,

same me patient falls out of bed, loosing a chest tube, thank goodness he did not have ballon pump

i don't mean to be so sarcastic, There are some necessities, I hate restraints, but sometime it truly is pt safety

Yes . you are right but in one large muti site study in USA , researcher have found that 44% of patients were restrained at the time of device removal .

if it is the case , what is the solution? The updated guidelines encourage program aimed at reduction of restraint use in ICU ... Any ideas ?

The word extubation autocorrected to extraterrestrial and the image of a patient turning into an alien and breaking out of the restraints came to mind when I read this thread...so my first thought was run!!!

calivianya, BSN, RN

Specializes in ICU.

I think restraint use is unavoidable in most ICU patients. Some are calm, but most are not. You can go without restraints when patients are deeply sedated, but by default, they are not going to be deeply sedated when we are trying to extubate them, so the most likely time for patients to be restrained is immediately before ETT removal. I don't think restraint use at time of device removal is really a fair measurement of restraint use because that's when patients are going to be the most awake and able to pull things out.

I worked at a hospital that used a ton of safety sitters in the past. That is a way to reduce restraints, however, it does require paying an extra body to sit in the room 24/7 and jump up every time the patient reaches for something. Most hospitals are not willing to pay out this sort of money to keep patients safe. Just restraining the patient is a heck of a lot cheaper.

Music, reassuring, try to maintain day & night patterns. Tell patient frequently where they are, who you are, what you are doing/plan of care, date & time.

I have been able keep patients out of restraints who were intubated with invasive lines, just depends on the patient.

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience.

Untied mitts maybe?

Otherwise, we use them when our nursing judgment says they are necessary; when they aren't, we don't. Sure if the pt is medically paralyzed, is tetra or hemiplegic, or is A&O and not sedated, restraints are not necessary. Nowhere I've worked has encouraged staff to restrain paralyzed limbs. It's not LTC where people are stable and in their home. ICU pts have art lines, central lines, ECMO lines, LAVDs, heck even peripheral access which can be a matter of life and death. ..gadgets inside their skulls like EVDs/Licoxes/Bolts... artificial airways...any number of things. Plus they are on a lot of meds which alter the LOC, and are not always their A&O×4 selves. Now those above listed lines and tubes can be seen not as safety measures, but discomforts the pt must protect him/herself from.

In those cases, the benefit greatly outweighs the risk.

RN., MSN, RN

Specializes in Perianesthesia. Has 30 years experience.

I would look at sedation vacation and a good delirium assessment tool which have a ton of EBP behind them, versus one study with a conclusion about restraints.

Restraints are the one stop shop for success. Makes your job easier as well. Everyone wins. Patient can't do harm to themselves and you don't have to be worried about the "what if's" of your patient roaming free.

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

Yes . you are right but in one large muti site study in USA , researcher have found that 44% of patients were restrained at the time of device removal .

if it is the case , what is the solution? The updated guidelines encourage program aimed at reduction of restraint use in ICU ... Any ideas ?

The solution to what the study found is that the other 56% should be have restrained, and the 44% who were restrained should have been restrained better.

From an overall patient care and outcomes standpoint, there really isn't a recommendation to get rid of using restraints. There are those who only look at the restraints portion and suggest we just not use them, which of course requires going back to excessive sedation levels which has far more risk for patients than restraints do.

critical<3s

Has 4 years experience.

We rarely use restraints in our CTICU. We put mitts on most vented patients, and sometimes non-vented, but confused, patients. Self-extubations are pretty rare. Patients pulling a-lines and IJs is not unheard of, though… And then we just work without. Per our protocol, we can use restraints on vented open hearts for the first 4 hours without an order, but I don't even see that happening often. I guess we're so used to working without restraints, we don't even think to use the protocol. Mitts tend to be pretty effective for those patients.

Edited by critical<3s
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