"restraint" policies

[elizabells, BSN, RN]

Yes, another procedure thread from me. Can you tell I'm going out of my MIND being away from the NICU?

So "my" unit recently discontinued two practices that could be thought of as restraints. One was pinning down the IV armboards. They'd tape the limb to the armboard on either side of the joint and then safety pin the distal end of the armboard to the bed. Reasoning for this is fairly straightforward: people were tired of IVs occluding when the babies bent their arms. Apparently JCAHO felt this was a restraint.

The second was tying paci's on. I never saw this done as the practice had been DC'ed by the time I got to the unit, but as it was described to me, they'd tie two lengths of the tan stockinette to the paci and then (LOOSELY) tie them behind the babies' head. Parents were told never to do this at home, that we could do it (like prone sleeping) because all babes are on monitors. The story is that when social work visited a NICU grad after discharge, they found the mother was DUCT TAPING the paci to the baby's face, and a report was made to child services, and the mom told them that our unit was Tegaderming paci's on, and she learned it from us. So that had to stop.

What are y'all's thoughts on this? Was it bad practice? Is it wrong that these were banned? Do your units still use either of these practices?

[BittyBabyGrower, MSN, RN]

With the armboards...our hospital doesn't say that is a restraint...we asked in our JCH meeting last year. We don't even have to do the module on restraint because it doesn't apply to us.

As for the pacifier..nononono! First off, the parents will mimic this, no matter if you tell them not to and also the risk for aspiration if the kid throws up is pretty high, esp if it tied on. Loosely to one person may not be the same as the next.

[babynurselsa, RN]

I have threatened more than once to affix the paci to the grumpy baby's face. To ever do it NEVER. Do as I say, not as I do does not work in the NICU. This is a dangerous practice.

[Gompers, BSN, RN]

Some of our nurses will safety-pin IV boards to the bedding out of habit. I personally try to get an armboard positioned on the IV so that the baby isn't able to bend and occlude the area where the catheter is. Sometimes this means a larger armboard than others might use, but I hate picking up a baby where the hub is taped to an armboard, but the baby keeps bending precicely where the catheter is, and it infiltrates within hours. I've been known to retape lots of IVs because I'm so anal about it.

Now, the only times I'll personally pin or tape an armboard to the bedding is when I'm giving a blood transfusion, large saline bolus, or sodium bicarb. In those situations, I just feel more comfortable being able to see the site at all times without having to keep bothering the baby.

We never never never tape or tie pacifiers to babies. NEVER.

We have a few of those Soothies that are attached to beanbag animals - we get them as samples - and we save them for our crankiest babies who really really need that pacifier. Most of the time they are given to babies who are being weaned off morphine and going through withdrawls. Those are great - especially the frog-shaped ones - because the baby embraces the animal and always has the pacifier near their mouth. If we don't have those available, we'll tape a pacifier to either a washcloth or blanket roll, so the baby can embrace that instead. They can easily turn their heads or lean back and lose the pacifier - so if they vomit, they don't have it stuck in their mouths.

[dawngloves, BSN, RN]

Anything that will restrict a pts ROM is a restraint.Back when I did adults we would get a docs order q 24 hours for restraints. Perhapes you can do that or re evaluate how you are taping your IVs.

I'm sorry, but my mouth was hanging open when I read about the pacifiers.We do the same as Gompers, (I swear we work at the same hospital sometimes!). It's a poor man's version of the little animals they sell for the Wee Soothies.

http://wubbanub.respironics.com/

[fergus51]

We never tape boards to the bed. I have never found it necessary.

The paci thing is crazy.

[elizabells, BSN, RN]

We never tape boards to the bed. I have never found it necessary.

The paci thing is crazy.

Good god. I'm starting to rethink my opinion of this NICU. We do use the stuffed animal paci's now when we can get them. They're rare, though, so if they get dropped on the floor the parents take them home and wash them rather than getting another.

Caveat: I have no idea when this practice of tying them in was stopped. For all I know it was ten years ago and people are just still talking about it.

[fergus51]

I wouldn't be too quick to judge. I've worked in several NICUs and every one of them has at least one thing that I think is nuts. No unit is perfect. My friend recently worked in a place that didn't believe in gavage feeds or caffeine.

[elizabells, BSN, RN]

I wouldn't be too quick to judge. I've worked in several NICUs and every one of them has at least one thing that I think is nuts. No unit is perfect. My friend recently worked in a place that didn't believe in gavage feeds or caffeine.

What did they do instead of gavage? All on syringe pumps? I know a lot of units are different. We use NCPAP like it was going out of style, and I know some units don't use it at all. But then, the guy who invented CPAP is an attending on our unit, so there you go.

[fergus51]

What did they do instead of gavage? All on syringe pumps? I know a lot of units are different. We use NCPAP like it was going out of style, and I know some units don't use it at all. But then, the guy who invented CPAP is an attending on our unit, so there you go.

They had their kids on TPN/IVFs until they were able to nipple all their feeds. Crazy huh?

[elizabells, BSN, RN]

They had their kids on TPN/IVFs until they were able to nipple all their feeds. Crazy huh?

Um, did any of the babies have functioning livers by the time they went home? Jaysus. What on earth could be the rationale behind that?

[fergus51]

Um, did any of the babies have functioning livers by the time they went home? Jaysus. What on earth could be the rationale behind that?

I have no idea. Apparently my friend got into it with the doc over that. The doc mumbled something about "some studies" and my friend demanded that he show her those studies, then said "but you can't because they don't exist":lol2: She's not a shy girl. There is no way the potential for liver damage and infection (from the piccs) or infiltrations could possibly make not gavaging a good idea, but they don't do it. The nurses there believe gavaging will interfere with the baby learning to eat (like the child will get used to passively being fed and be unwilling to bottle later). This is the danger of nurses working in only one unit and not ever updating their knowledge base. I thank God for resources like allnurses and conferences because they give me a chance to keep up to date on what other units are doing.