Restraining critical patients with heroin overdoses

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What are your thoughts on restraining of critical patients with overdoses before you give them narcan. We frequently have patients coming in with heroin overdoses and instead of restaining them before giving the narcan, we give the narcan and wait to see what happens. If they get agitated or violent then we get security officers to hold them down and maybe restrain them.

I feel that this is a dangerous practice in that I had an unsheathed IV needle shot at me when a pt became unruly when we were inserting a second IV. I have been kicked, kicked at, and had the patient rip out his IV and try to pull out an ET tube. I have had to catheterize a pt who was "held down" by security. They let go too early and the patient kicked out and sprayed the cath kit everywhere including urine. I believe as we are working on bagging and intubating starting IV's the security should be putting on restraints. This way if the patient becomes violent we are safe,if he remains docile we take them off. My coworkers disagree they take a wait and see attitude. I thought personal safety was foremost why risk it?

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I doubt the joint would allow a pre-emptive restraint policy. Everything is about JCAHO nowadays...

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It's not just Joint Commission -- what you are describing/proposing would be a violation of CMS (Federal gov't) and, probably, your state hospital licensing rules, also.

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What is the difference between that and restraining an intubated pt on a respirator. All patients on respirators are restrained with soft restraints and that is ok with JACHO. Just because we are bagging the patient instead of putting a respirator on the patient what difference is it. As soon as he wakes up we are going to do it as well only now everyone including the patientis at risk for getting hurt.

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Specializes in Nephrology, Cardiology, ER, ICU.

You can restrain for tube integrity. That's what I would do. The velcro Too Tough restraints work great.

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Specializes in Peds Cardiology,Peds Neuro,Pedi ER,PICU, IV Jedi.

In agreement with the above posters, you can, and probably should, restrain them (with soft restraints or the minimum amount necessary for safety) prior to giving the Narcan. Having had the above situation happen to me several times...you learn quickly. And you're right- your safety, as well as the safety of your patient, is your primary concern.

Give that narcan slowly, and stay away from swinging arms, legs, and TEETH. Stupid people do crazy things coming out of their "high".

Have a great day.

vamedic4:)

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Specializes in Nephrology, Cardiology, ER, ICU.

Soft restraints are easily broken - by anyone except the elderly and frail. I still vote for the Too-Tough - never seen anyone break them once they are applied properly.

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Specializes in Peds Cardiology,Peds Neuro,Pedi ER,PICU, IV Jedi.
Soft restraints are easily broken - by anyone except the elderly and frail. I still vote for the Too-Tough - never seen anyone break them once they are applied properly.

If by "soft" you are referring to those poseys or other restraints used in the hospital...sorry, I was referring to a triangular bandage..tied correctly I've never had anyone slip out. Flat sheets can be used if necessary, as well.

Sorry for the misunderstanding..but traumaRUs is right...most "soft" restraints are a joke when it comes to restraint.

vamedic4

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Out of curiosity are the intubated patient's sole problem heroine overdose? Or are they intubated for other reasons in addition to the heroine? There is no reason to justify intubating a patient solely for decrease respiratory drive due to heroine overdose if narcan is readily available, and that includes the pre-hospital environment.

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Specializes in Nephrology, Cardiology, ER, ICU.

vamedic - sorry about the confusion. In the hospital I worked at, we were only allowed to use the "soft" Posey- wrist restraints or the Too-Tough. No triangular bandages, no sheets. (Unfortunately - lol).

Soliant12 - many times when patients come in to the ER, they already have decreased resp drive and associated decreased level of consciousness which precludes us from questioning what they took. So...as the old saying goes: airway, breathing, circulation and voila - they get intubated so we can buy time to figure out what is going on.

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Specializes in Emergency.

How about giving less Narcan. Back when I first learned about its use the whole point of giving it was to give it till respirations improved not until the patient wakes up.

So I guess my point is if the patients respirtory rate is fine I would hold off on giving it. Also as one of the other posters mention we have different restraint protocols one for tube/lines/stroke pts and another for agressive behavior.

The tube/line one can be used on almost anyone, where as the other comes with more restrictions. For example the first is good for 24hr and the other needs renewal every 4 hrs at my facility.

Rj

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That is the same policy our hospital has. However, if you have a patient on sedation and on the vent and have the soft wrist restraints that is considered double restrained and is against JACHO policy. Any time you use medication to sedate or control a patients behavior that is considered chemically restrained and no other form of restraint is allowed. We even have to fill out restraint checkoff sheet every hour on these patiens just like the ones that are phyiscally restrained.

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