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SPIT AT....AGAIN!

Emergency   (16,522 Views 54 Comments)
by ThrowEdNurse ThrowEdNurse (Member)

ThrowEdNurse has 5 years experience and works as a ED Staff Nurse.

3,907 Visitors; 298 Posts

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I am so tired of being spit on by patients! We all know the aggressive, out of control patients that spit. You're attempting four point restraints, they're growling snarling, someone holds their head so you won't get bit as 10 people try to restrain the maniac then comes the sound.....hawk! That I-am-collecting-a-large-loogey-in-the-back-of-my-throat-to-hit-you-in-the-face-with-sound. Anybody have a solution. Clearly regular masks don't work because they thrash around, get them dislodged, plus you risk being bitten while placing it. I was thinking bipap but it's pretty hard to get an order for bipap because someone is violent. Anyone come up with a solution for spitters? They're pretty hard to control. Our psych population has been unusually high lately for the summer and my fuse is wearing short.

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CVmursenary has 1 years experience.

6,037 Visitors; 240 Posts

Haldol and a tazer

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Reno1978 has 6 years experience and works as a SRNA.

15,178 Visitors; 1,133 Posts

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.

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6,876 Visitors; 272 Posts

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....

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Flo. has 7 years experience and works as a RN.

8,049 Visitors; 571 Posts

I second the spit hood.

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Larry77 has 10 years experience and works as a Associate Manager ED.

8,370 Visitors; 1,158 Posts

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 :-)

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nursinger has 40 years experience and works as a staff nurse.

2,931 Visitors; 129 Posts

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

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Altra works as a staff / charge RN in a teaching hospital - I work .

40,127 Visitors; 6,255 Posts

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.

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nursej22 has 30 years experience as a MSN, RN and works as a royal pain in the tuchus.

1 Follower; 33,835 Visitors; 1,267 Posts

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

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Reno1978 has 6 years experience and works as a SRNA.

15,178 Visitors; 1,133 Posts

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.

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mskate has 8 years experience.

5,903 Visitors; 280 Posts

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.

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6,288 Visitors; 517 Posts

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.

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