self extubation

GrannyRRT · Aug 16, 2014

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.

MomRN0913 · Aug 17, 2014

I have had my fair share of self extubations. It's happens. Some even manage to tongue the tube out!

most of the time my self extubations were ready to come off the vent.

It happens often, don't beat yourself up over it.

GrannyRRT · Aug 17, 2014

But, don't just dismiss it as something which just happens or use the "ready to come of the vent anything" excuse either. Use each event as a learning tool. Self extubation is not always benign and can have serious consequences depending the reason for intubation, the type of ETT and the cuff pressure. If this is happening as frequently as some say it is, it might be time to establish a tracking procedure for review. We run well over 100 ventilators, including neo and pedi, almost everyday and now have self or inadvertent extubation down to a very rare occurrence.

Guests · Aug 19, 2014

One of my pod-mates had a patient self-extubate last night.

The patient was young and fit - came in GCS 3, apparently d/t intoxicants.

Patient was metabolizing the intoxicants and becoming more reliant on the prop/fent to stay down... but wasn't able to follow commands so not yet a candidate for extubation. The team came down to the ED and told the nurse to start going light on sedation so they could evaluate the patient. As the patient got light, the patient started getting agitated. The nurse went to the phone to inform the team that the patient was coming up fast and either needed to be evaluated or put back down. When s/he walked back in, the patient had extubated by a combination of tonguing/chewing and thrashing his/her head about.

This is contrasted with another intoxicated patient from last night who got light just prior to transport to the ICU but was able to be calm and cooperative... and (I presume) ultimately extubated in a safe and controlled fashion.

The point is, even the most tightly restrained patient, when they go light on sedation can pop that tube in no time at all unless the nurse is continuously at the bedside.

While it shouldn't be accepted as "eh, it happens...," it is, in fact, not something that can always be prevented.

ICUNurseG · Aug 22, 2014

It happens. I've had it happen and I never leave the room without double checking restraints. Other people don't always tie them tight enough or correctly. You live and you learn. Don't beat yourself up.

montinurse, BSN · Sep 2, 2014

I was going to comment that I've seen it done with their tongue, but someone already has. Frustrating and irritating when I'm trying to keep them on the least amount of sedation as possible, but it happens to us all!

SCBlueICU · Sep 2, 2014

I think it happens to everyone sooner or later. The way people can bend sometimes is unreal. Obviously we do everything we can to stop people from doing it, but sometimes there isn't a lot you could have done about it. I've never seen one of our doctor's lose it when a patient self extubates. I have a friend that is a doctor that doesn't understand why the nurses get so freaked out about it. In short, the fact that you're analyzing it after in your head means you're going to try something different next time, which is all you can ask for.