self extubation

Published

My pt self extubated this morning and i feel beyond guilty. I wish i could turn back time and make sure that restraint was tied just a little bit tighter. I love being a nurse but some times its hard to leave work at work and not bring home guilt like this. My patients loved ones are counting on me to keep them safe......

Up Vote Up Vote ×

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.

Up Vote Up Vote ×
Specializes in ICU, ED.

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

Up Vote Up Vote ×

thanks for the support :)

Up Vote Up Vote ×
Specializes in Critical Care.

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!

Up Vote Up Vote ×

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.

Up Vote Up Vote ×

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!"

Up Vote Up Vote ×
Specializes in SICU, trauma, neuro.

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!

Up Vote Up Vote ×

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!

Up Vote Up Vote ×
Specializes in ICU/PACU.

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.

Up Vote Up Vote ×
Specializes in ICU.

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 :)

Up Vote Up Vote ×
Specializes in Pediatric Hematology/Oncology.

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.

Up Vote Up Vote ×
+ Join the Discussion