Restraint use in ICU

[Abetterway, BSN]

Our ICU uses wrist restraints on intubated patients, sedated and unsedated. Just this week a gentleman that could not even withdraw to pain, on or off sedation , had bilateral wrist restraints. I got them discontinued. What to do? We are in the last century with restraint use. Any advice? 

[MunoRN, RN]

I feel like it was the 'restraint-free-ICU' fad that was last century, but I do agree that there are some patients where restraints aren't needed when intubated, but it's fairly rare, examples would include brain dead patients and those on continuous paralytics.  

It's one thing to use restraints conservatively where you aren't protecting a life-support device, but risks of unplanned life support device removal shouldn't be taken lightly.

I've seen comatose patients self-extubate due to decorticate posturing.  But the worst case I've seen was a young guy, early twenties with Ludwig's angina resulting from a tooth abscess.  He wasn't any 'altering' medications and was with-it.  He had been sleeping and then apparently pulled out the tube while still half-asleep, he hit the call light and staff found him trying to put in back in himself.  His airway had completely closed due to the swelling, attempts to reintubate failed, an emergency cricoidectomy was performed but by that point he had permanent anoxic injury, he's been semi-comatose at a vent-farm ever since.  

[zoidberg, BSN, RN]

IMO, it is a safety issue to not have restraints. Anything can happen in the ICU, and I am leaving them on just in case. If you have them on the correct way, they will not harm the patient.