self extubation

Some people are contortionists, no matter how tight the restraints are they can sometimes get to it.

You can't stand over them 24/7. Does it suck that it happened, yes, do you need to beat yourself up about it, no.

Agree with the pp! Some patients just houdini out of their restraints, don't beat yourself up.

thanks for the support :)

I've had a bunch of people self extubate. Yea, you feel crappy about it, but most of the time you can't help it. They did it to themselves!

You know what? It happens.

It would be nice if it didn't but... it does.

You do your best to monitor the patient and sedate them appropriately... and keep them suitable restrained... but sometimes... it still happens.

It is very difficult to have a patient that is simultaneously safely and completely restrained... it's even more difficult to maintain that.

When they get light on sedation, they can come up fast and strong, and sometimes extubate themselves just with their head and upper body. If you're not right there when it happens, it's terribly difficult to prevent.

~~~

And even if it was an error -- and all on you -- you still need to let it go and leave it behind. Trust me on this one... I know from painful, first-hand experience. Errors can happen to good nurses who are trying their best.

Had that happen to me a while back and to make things worse I had a student with me...luckily the patient did fine and the docs joked "well, they must have known they were ready to have the tube out!"

One of my nursing school instructors had a pt self-extubate WITH HER TOES.

My unit had this one LOL who self-extubated 3 or 4 times with her wrists tied tightly. She would reach her head down to wherever her hand was tied, grab hold, and sit herself up.

It happens--don't beat yourself up!

One of the most experienced nurses on my unit (like, 25+ years in ICU) recently had a patient self extubate. Respiratory therapy saw the patient (90+ years old, post surgical, very weak prior to surgery and more so after) contort himself in an extremely elaborate way, practically dislocating his shoulder, just to get it out. It's human nature to want to get whatever is in our mouth/throat out. Don't beat yourself up, it happens!

It happens to us all. I haven't had a self extubation in a few years, but I did have someone pull out her subclavian central line at shift change, while my other patient was crashing.

As Nurses we are harder on ourselves than ayone else it. That is our nature to protect people and make sure they are safe. You just cannot control what others do. Patients will do ANYTHING to pull a tube that is irritating them. It happens to eveyone. Don't be so hard on yourself :)

This happens - a lot --- even with a sitter.

I can't imagine being intubated is comfortable at all especially if the pt has a modicum of awareness. Like everyone said, at the end of the day, they did it to themselves. I am coming to think of this as just a potential complication of intubation which, therefore, requires a new plan to implement to deal with this complication. Don't feel bad. It's always that last second that someone self-extubates, gets out of bed and falls, pulls out their IJ, etc. etc. Unless you stand over them ready to get involved it's going to happen if the pt wants to badly enough.

In the ICUs here both the RN and the RRT fill out a rather lenghty form which covers the physicians, medications, restraints, ET tube type, suction device placement, tube fastener, tube retaping and by who and last visual check. The data is reviewed by the medical directors of RT and ICU. Problem areas are addressed and the RNs and RTs might be called in to give more information. Just like falls, unplanned extubations are something we want to prevent if possible although a few will happen regardless. We want to do anything to prevent a sentinel event if at all possible.