what do you think??

Published

So we had a patient who kept trying to pull out their NG tube (they were very combative about getting it inserted as well, biting staff, etc....but it was medically necessary and the pt is on a commitment). Anyway, my question is: if the patient keeps grabbing & grabbing trying to pull the tube out while in restraints and then they fall asleep...technically should the restraints be removed from them because they are in theory no longer exhibiting the "problem" behavior? It's kind of a catch-22 because of course as soon as you go to take the restraints off, you know the pt will wake up and start trying to pull at it again.... I'm just confused about legality issues. I'm inclined to think it is ok to leave the restraints on as long as you do ROM and skin integrity assessment?

thoughts? what would you do in this situation?

Up Vote Up Vote ×
Specializes in Community Health Nurse.

I agree that "it is ok to leave the restraints on as long as you do ROM and skin integrity assessment?"

Also, a CNA could be assigned to the patient at all times to assure safety while in restraints. I believe the rule is to assess and unrestrain the patient every two hours during use of medically necessary restraints in place on a patient.

Up Vote Up Vote ×
Specializes in Telemetry, CCU.

Since you can't predict how long the pt will be asleep, it is okay to leave the restraints on, as long as you are doing your checks every 2 hours. A sitter would be nice, but it sounds like even in your situation, a sitter may not be able to stop the patient from pulling stuff out in time if restraints were off.

In situations like that, its best to leave the restraints until the patient is calm, then try untying them to evaluate how the pt acts with them off, while supervised. Leave the restraint around the wrist while you do that just in case she makes a move for the tube.

Up Vote Up Vote ×
Specializes in Oncology, Triage, Tele, Med-Surg.
I believe the rule is to assess and unrestrain the patient every two hours .

:yeahthat: Let the patient sleep between the mandatory 2 hr release/checks. Also see if a chemical restraint or pain meds might be an option to make the patient more comfortable and able to tolerate the NG.

Up Vote Up Vote ×

And don't forget to document..document..document to cya

Up Vote Up Vote ×
Specializes in psych, addictions, hospice, education.

Why does the patient try to remove the tube? Can the patient tell you? Maybe there's an underlying issue that can be dealt with!

I'm concerned about forcing a patient to have an NG tube. Commitment generally means the patient can be hospitalized against his or her will, but forcing particular treatments requires more than the commitment (at least it does in my state).

Up Vote Up Vote ×
Specializes in tele, oncology.
Why does the patient try to remove the tube? Can the patient tell you? Maybe there's an underlying issue that can be dealt with!

I'm concerned about forcing a patient to have an NG tube. Commitment generally means the patient can be hospitalized against his or her will, but forcing particular treatments requires more than the commitment (at least it does in my state).

Crikey, I can't tell you how many times I've had patients who are restrained for trying to pull out NG/PEG/BiPap/IVs...

I've had totally demented patients who are on cardizem or amiodarone gtts for rate control, ones who have NG's due to ileus or SBO, ones who are on BiPap to try and keep from tubing them...when you can't reason with them, and they're a full code, what are you supposed to do? It's why there's rules stating that we can restrain when medically necessary.

Obviously, as soon as medically possible, other treatments should be pursued which don't require the restraints for compliance.

Also, we just had our blitz, and were told that we are no longer allowed to do trial releases...any time the restraints are off for longer than is necessary for ROM etc. we have to get a doc's order to reapply.

Up Vote Up Vote ×

I would leave the patient alone and let her sleep.

Trying to take the restraints off would just wake her up and she would reach for her tube.

Many of our patients suffer from serious sleep deprivation.

Enough sleep deprivation can make an otherwise sane person go beserk.

Up Vote Up Vote ×
Specializes in ICU, CM, Geriatrics, Management.
Why does the patient try to remove the tube? ...

Excellent!

We need to ascertain this. Are there physical / psych / psychosocial / cultural reasons? Review the history, consult the family, inform the MD.

Are they in pain, depressed, sleep-deprived, etc.? Numerous possibilities really.

Once we identify the cause(s), we need to address them and attempt to solve the patient's issue with appropriate interventions. If one attempt at correction doesn't work, try an alternate theory of the prob, and also implement alternative interventions. Keep searching for solutions.

Until then, keep the restraints and carry on as indicated by previous posters.

Up Vote Up Vote ×
Specializes in psych, addictions, hospice, education.

I asked the "why" question because the OP did not say what the area of care is, and her specialty is psych. This is entirely different than if you're in ICU or LTC...

That being said, assessing the "why" is always pertinent...

Up Vote Up Vote ×

What is your disipline?

Up Vote Up Vote ×
Specializes in tele, oncology.
I asked the "why" question because the OP did not say what the area of care is, and her specialty is psych. This is entirely different than if you're in ICU or LTC...

That being said, assessing the "why" is always pertinent...

Ah, I should have checked on that...I'm looking at things from a tele/step-down POV, and you're looking at it from a psych POV.

From where I'm at, oftentimes the "why" is being addressed by the treatments that the restraints are required for (i.e., hypoxia, glycemic imbalances, cardiac issues, pain/nausea from SBO, lyte imbalances). Kinda a frustrating catch-22.

Up Vote Up Vote ×
+ Join the Discussion