SPIT AT....AGAIN!

Haldol and a tazer

Bipap would be contraindicated for restrained patients.

Our ED has what they call "spit nets" available. They look similar to the mesh hoods that a beekeeper would wear sorta.

I don't know that BiPAP would be contraindicated for restrained patients -- don't understand that statement. BiPAP would be contraindicated for someone without respiratory compromise, however....it's non-invasive ventilation. Why would a spitter need that?

I personally like brandon's response. Why can't nurses have tazers? It would make life so much easier....

I second the spit hood.

Spit hood, restraints, then Haldol/Ativan...sometimes security throws in some tazer action. Plus remember you can press charges when you've been spit on...is assault and in my state assaulting a licensed caregiver is a class C felony :-)

Spit hood. If no spit hood, towel over the face.

So sorry, ThrowED. For you ... hugs, and your favorite adult beverage.

For the perp ... a surgical mask, 4-pt. restraints, & Vitamins H & A. And yes, a police report -- spitting is assault.

Not seen it personally, but I'm told our ED uses the disposable mesh panties we have for holding peripads in place.

I don't know that BiPAP would be contraindicated for restrained patients -- don't understand that statement. BiPAP would be contraindicated for someone without respiratory compromise, however....it's non-invasive ventilation. Why would a spitter need that?

I personally like brandon's response. Why can't nurses have tazers? It would make life so much easier....

BiPAP can result in the swallowing of air and can induce vomiting, so the person has to be able to remove the mask themselves if they vomit, which wouldn't be possible if their limbs are restrained.

We restrain Bipap patients a lot. If they are confused with a co2 through the roof and unable to ventilate properly, we restrain them for their own safety. Of course they are not ignored in the back corner of the unit, but allowing someone to continually pull of a mask when they are not with it endangers their health massively.

Bipap is contraindicated for patients without distress. Medical restraints are contraindicated for patients who are appropriate and "with it". Restraining confused patients and assisting them with ventilation is saving their life. If you have an alert patient that is appropriate, sure, don't tie them down. If you have an alert and oriented patient who is simply unable to tolerate bipap - consider other options - including intubation.

That being said - i will sometimes just put surgical masks on patients who cannot keep their sputum to themselves.

We restrain Bipap patients a lot. If they are confused with a co2 through the roof and unable to ventilate properly, we restrain them for their own safety. Of course they are not ignored in the back corner of the unit, but allowing someone to continually pull of a mask when they are not with it endangers their health massively.

By your profile it seems you work in the ICUs. BiPAP patients with direct supervision can be restrained. However it is not appropriate practice for med-surg or a busy ED. Also, a struggling patient will be out of synch with the machine and it will be of little benefit to the patient. HFNC may be more appropriate if oxygenation is an issue or even intubation if CO2 clearance is the problem.

For spitting, I do like the spit nets.

If a surgical mask isn't working, then try the spit net or a non-rebreather mask. The NRB works well since it has the elastic strap. And if they say no to that because its high flow O2 without an order, just pull off the valve covers so they don't need to be hooked up to the O2 at all.