I work in the neuro ICU, we have our fair share of non intact pts that are restrained for typical reasons. However, at times we have totally intact pts, some of these patients have EVDs or LDs (brain drains).
I had a pt the other night who was completely intact. She was a picker though. Im sure you all know the type..picking at her IV (redressed it 4-5 times), picking at her foley, pulling off her O2 and BP cuff all night long..etc..all that I can handle, its a pain running back and forth between my 2 pts all night, but if she pulls out an IV, well then I can always put another in. HOWEVER....I spent many hours at the beg. of my shift and all during the shift explaining to her the dangers of an EVD and how it works by gravity..so sitting up or moving the bed down effects how it drains CSF. She verbalized understanding each time. I also tell her, don't touch the EVD bc its a huge huge source of infection.
I can only be one place at one time. THe next thing I know she is sitting straight up trying to get out of bed with the EVD attached. I almost have a heart attack. Still, again, I try and educate her, although this time stress that she could die if she dumps too much CSF. She verbalizes understanding.
Through the rest of the night I spend my time babysitting her, keeping her in bed and relatively still. I constantly remind her not to touch the EVD and she kept doing it.
By the time the resident rounded I was almost out of my mind and I felt my only option left was to restrain her. I know it might have kept her in bed and from touching the EVD (her drain was leveled at 20 so she wasnt at as much danger of dumping CSF as others with lower drains) but I just couldn't do it. This was the same pt that threatened to scream if I didnt give her something to drink while she was NPO or threatened to check herself out AMA if I didnt let her go to the parking lot to smoke (no way! esp. with an EVD????).
I had visions of her kicking and screaming and her BP way over 200...I just thought maybe through more education and careful watching I could avoid both potentially dangerous sitiations. Like I said though, by the time 0500 rolled around I was almost nuts. THe resident gave her the EVD talk and told the pt flat out if she didnt stop she would be restrained and if she wanted a raging meningitis infection to keep touching her EVD.
Sorry for the long vent, I guess my question is: have you ever had to restrain an intact pt. and how did you handle the situation, ie how did you approach them initially, how did you problem solve...guess just ooking for some advice on this sitation if i ever have to face it again, which im sure i will. Thanks.
I fall in the "I'll believe what you do not what you say" category. It sounds like you tried many interventions to avoid restraints and they were failing. It sounds as well that although she could verbalize understanding, she truly didn't get it. The only options left are restraints and 1:1.
In the last ICU I worked at we went through this period when policymakers decided not every vented patient needed to be restrained. Restraints were ordered off, even when we at the bedside felt that many were just not with it enough to remember instructions. This policy was followed by a rash of self-extubations and subsequent reintubations. That got old quick- in about a month the policy was reversed to give the nurses at the bedside more say in making that decision. Sometimes restraints are used needlessly, but they do have value in providing patient safety in those situations when 1:1 staffing is not possible.
Pump her up with some Mephobarbital and we'll be all set for the rest of the night
I've had to restrain an intact patient in the ER when I first started. She came in there all hyped up on sugar or something (she was only 15 or 16) and was complaining and severe nausea (every 10-15 minutes she'd be throwing up... come to find out it was from the strength of the antibiotic her MD prescribed her). Anyways, I started an IV and no sooner than I got back to the nurses station she screamed. I rushed back in there and she RIPPED her IV right out of her arm (now she was bleeding).
I called another nurse in to administer IV access while I stopped the bleeding. As we were doing that, she barfed all over the other nurse - so she had to go change immediately (young girls... sheesh what babies lol). I then called two other nurses in there to help put the IV in and clean up the mess. Now, here is where it starts: she then started to scream at the top of her lungs for no reason at all when we all were in there.
She started thrashing her legs and kicked one of the other nurses in the nose (so now she was dripping blood). We were all yelling at her to calm down so I just said "Enough!" - ran out to the nurses station, grabbed some leg restraints and tied her down! She stopped immediately and then I gave her the lecture of ripping IV's out and how abuse would not be tolerated. By then, someone called security and they were down there talking to her as well.
So yes... I've had to restrain pt's :)
You think she was abusing you? It sounds more like she had a personality change due to her electrolytes being off. Plus, even though it is understandable that you brought in other staff to help you, she probably felt ganged up on and got scared, especially since you were all yelling at her - this in addition to the effects of having her 'lytes off.
Sitters are great. I wish we had more. I had a patient one night who wasn't a neuro patient, so already I was out of my element. This pt. was a psych/medical pt. who swallowed an entire bottle of pills and she would eat things to get attention. This time she broke a tv ant. in 3 pieces and swallowed them ended up with a laryngeal tear. This pt was totally out of my leauge. She, other than obs having some psych issues was intact. We didn't have her restrained and being that she was on suicide precautions she was ordered by her MD a 24/7 sitter. Well, I couldn't even get one that night. I had to be the sitter. I just had her that night but I couldn't leave my desk all night.
Where I work, patients who eat foreign bodies such as glass, antennas, etc., really weird items, get 2:1 24/7.
I work in the neuro ICU, we have our fair share of non intact pts that are restrained for typical reasons. However, at times we have totally intact pts, some of these patients have EVDs or LDs (brain drains).
I had a pt the other night who was completely intact. She was a picker though. Im sure you all know the type..picking at her IV (redressed it 4-5 times), picking at her foley, pulling off her O2 and BP cuff all night long..etc..all that I can handle, its a pain running back and forth between my 2 pts all night, but if she pulls out an IV, well then I can always put another in. HOWEVER....I spent many hours at the beg. of my shift and all during the shift explaining to her the dangers of an EVD and how it works by gravity..so sitting up or moving the bed down effects how it drains CSF. She verbalized understanding each time. I also tell her, don't touch the EVD bc its a huge huge source of infection.
I can only be one place at one time. THe next thing I know she is sitting straight up trying to get out of bed with the EVD attached. I almost have a heart attack. Still, again, I try and educate her, although this time stress that she could die if she dumps too much CSF. She verbalizes understanding.
Through the rest of the night I spend my time babysitting her, keeping her in bed and relatively still. I constantly remind her not to touch the EVD and she kept doing it.
By the time the resident rounded I was almost out of my mind and I felt my only option left was to restrain her. I know it might have kept her in bed and from touching the EVD (her drain was leveled at 20 so she wasnt at as much danger of dumping CSF as others with lower drains) but I just couldn't do it. This was the same pt that threatened to scream if I didnt give her something to drink while she was NPO or threatened to check herself out AMA if I didnt let her go to the parking lot to smoke (no way! esp. with an EVD????).
I had visions of her kicking and screaming and her BP way over 200...I just thought maybe through more education and careful watching I could avoid both potentially dangerous sitiations. Like I said though, by the time 0500 rolled around I was almost nuts. THe resident gave her the EVD talk and told the pt flat out if she didnt stop she would be restrained and if she wanted a raging meningitis infection to keep touching her EVD.
Sorry for the long vent, I guess my question is: have you ever had to restrain an intact pt. and how did you handle the situation, ie how did you approach them initially, how did you problem solve...guess just ooking for some advice on this sitation if i ever have to face it again, which im sure i will. Thanks.
She really wasn't all that intact, I'd say, and should have been restrained much sooner, to preserve her safety and your sanity.
Specializes in SICU, EMS, Home Health, School Nursing.
I have had to restrain "intact" patients before. I actually had one recently who could answer all my questions correctly, but he was a "picker"... he was a post-op belly surgery, so we had to restrain his hands so he wouldn't pull his dressing apart.
This is my nightmare when it comes to restraints; I walked by a room on another floor once and found an elderly man hanging from a posey vest and turning blue. He was still breathing and all, but it was too close.
Woludn't it be wonderful if you could call the local PD and press charges of assault against an intact patient who feels they can hit, bite, spit on and abuse a nurse? If I was a clerk in a grocery store and a client treated me that way they would be in the pokey and the only restraints used woud be hand cuffs. I know this is a little off topic but so many posts described oriented people commiting crimes against a nurse and we are the ones trying to figure out how to be theraputic towards them. ARRRRGH!!!! Six mos in the county lock-up sounds very theraputic for some of these people. Its a shame our employers would never back us.
Ophelia78
103 Posts
I fall in the "I'll believe what you do not what you say" category. It sounds like you tried many interventions to avoid restraints and they were failing. It sounds as well that although she could verbalize understanding, she truly didn't get it. The only options left are restraints and 1:1.
In the last ICU I worked at we went through this period when policymakers decided not every vented patient needed to be restrained. Restraints were ordered off, even when we at the bedside felt that many were just not with it enough to remember instructions. This policy was followed by a rash of self-extubations and subsequent reintubations. That got old quick- in about a month the policy was reversed to give the nurses at the bedside more say in making that decision. Sometimes restraints are used needlessly, but they do have value in providing patient safety in those situations when 1:1 staffing is not possible.