Restraints too Tight?

[laxxrickLPN]

I am a first year nursing student and I have a question relating to restraints.

My father had respiratory failure and was on a ventilator in the ICU. When he was there, I noticed everytime I went in his wrist restraints were extremely tight and his hands swelled up horribly and the restraints began to cut his wrists. I loosened them everytime I went there, at least four times.

He was in the hospital more than a month ago, but he still has excruciating hand pain in the wrist that had the restraints on too tight. When he went back to the hospital, they are saying he has carpal tunnel syndrome.

I suggested getting a second opinion, because as tight as those restraints were, and the fact he'd never had a hand problem before he was in ICU last time, I feel that they may be saying CTS because they knew the restraints were too tight for very long periods of time.

My question is, isn't that the responsibility of the nurse to write in the care plan that the restraints need to be loosened so they are not cutting off circulation every so often?

[CHATSDALE]

restaints. when used, must be loosed enough to allow nurses fingers to easily slide between wrist and restraint

also restraints should be removed every 2/3 hours and patient reacccessed

[nightmare, RN]

restaints. when used, must be loosed enough to allow nurses fingers to easily slide between wrist and restraint

also restraints should be removed every 2/3 hours and patient reacccessed

What does " reaccessed " mean?

[laxxrickLPN]

Well, I think I may suggest that the chart be reviewed to see if that was performed. I picked up on it right off the bat... but carpal tunnel syndrome is a ridiculous diagnosis for his excruciating pain: that's a chronic condition and his pain has only been since his restraints were on too tight!

[Altra, BSN, RN]

I encourage you to contact his PCP or the physician currently most responsible for his care and ask for additional information related to the new dx of carpal tunnel.

I also encourage you to NOT adjust or otherwise "fix" restraints or other hospital equipment without bringing the issue to the attention of the nurse caring for the patient at that time. Soft wrist restraints are routinely utilized with intubated patients. I completely understand your concern, but unplanned extubation is also extremely unpleasant, to say the least.

Good luck with your studies.

[RNAnnjeh, MSN, CNS]

What does " reaccessed " mean?

Maybe reassessed?

If there is a patient representative service, perhaps accessing them to review the hospital's restraint policy with you may give you an understanding of how often the restraints should have been loosened, skin checked and reapplied.

Definitely an assessment from a family doc would be helpful.

[laxxrickLPN]

I also encourage you to NOT adjust or otherwise "fix" restraints or other hospital equipment without bringing the issue to the attention of the nurse caring for the patient at that time. Soft wrist restraints are routinely utilized with intubated patients. I completely understand your concern, but unplanned extubation is also extremely unpleasant, to say the least.

I was just mad at the extreme tightness. With a 1-to-1 nurse ratio in the ICU, there was no reason it was ever that tight while I was there. I loosened it myself because while I still only am a nursing student, I have learned how to properly use restraints.

I definitely wanted the restraints on, no doubt about it! He would have extubated (knowing him)!!

[Altra, BSN, RN]

With a 1-to-1 nurse ratio in the ICU, there was no reason it was ever that tight while I was there. I loosened it myself because while I still only am a nursing student, I have learned how to properly use restraints.

With a 1:1 nurse ratio, it seems appropriate for you to have taken your concern to the nurse, not adjusted equipment yourself.

Do you think it's possible you'll view this differently after you are a licensed practicing nurse and find that family of one of your patients has altered something related to the care of your patient without your knowledge?

Unplanned extubation is not a manifestation of orneriness, as you seem to imply in your dad. It can be life or death.

[RN1982]

As an ICU nurse, I would be extremely upset if a family member loosened or removed the patient's restraints. They are there for a reason. If you thought they were too tight, you should have mentioned it to the nurse and not have touched the restraints. Your father could have gotten a lot of fluid and that could have been an explanation for the swelling. If you father had been able to extubate himself after you fiddled with the restraints, that nurse could/would have been reprimanded. It's her/his license, not your's. Next time just ask.

[laxxrickLPN]

As an ICU nurse, I would be extremely upset if a family member loosened or removed the patient's restraints. They are there for a reason.

First of all, the issue isn't me loosening (not removing, I wouldn't do that!) the straps. It was originally the hand pain he is experiencing now.

The nurse was in the room. I told her I was loosening the straps and that they were too tight. I told her I was a nursing student and she observed me loosen it.

[RN1982]

First of all, the issue isn't me loosening (not removing, I wouldn't do that!) the straps. It was originally the hand pain he is experiencing now.

The nurse was in the room. I told her I was loosening the straps and that they were too tight. I told her I was a nursing student and she observed me loosen it.

First of all, not all restraints are made the same. I've seen patients rip through the cuff of the restraint because they were too loose. I wasn't aware that the nurse was in the room. Had you supplied that piece of info in the first place, I wouldn't have made the assumption that you did it without the nurse's knowledge.

[smk1, LPN]

You've gotten some good advice and opinions here. Without us being there to see the situation, we can't accurately make a judgement call. If you have questions regarding a new diagnosis the best thing to do is talk with the PCP and your father. If you are really concerned that this is a result of improper nursing practice, then you know where you need to go from there. Good luck in your studies.