Unsedated, vented patients?

[CrazierThanYou]

I am new to the ICU and therefore, new to vented patients. Last night, the OR team brought me a fresh post op patient. He was brought to the floor vented but unrestrained and unsedated, wide awake! Multiple nurses were holding him down while screaming at me to get some sedation and restraints.

Let me also add that no one called report to me on this patient or I would have been prepared if I had known there was no sedation on board.

What I want to know is, is this a common practice? Not calling report and not having already started sedation on a vented patient? The other nurse I was working with at the time said she has never seen such a thing in her life at other hospitals she has worked at.

I was told by other employees that this isn't the first time a vented patient has been brought to the unit unsedated.

[Here.I.Stand, BSN, RN]

I would write an incident report. Our postops are frequently brought up unsedated and unrestrained.........because paralytics are still on board. (We just know sedation is a priority once ICU orders are in.) None of this needing to hold people down. Also, the CRNA always calls report. Did either anesthesia or OR RN come with the pt to give a bedside report? If not, not cool.

[Jensmom7, BSN, RN]

I don't know, I was intubated when I coded after an anaphylactic reaction and I wasn't sedated. I know this was probably an exception.

Of course, it was a community hospital and we all knew each other. My nurses told me I could have sedation if I needed it, but I never did.

Frankly, the NG tube annoyed me more than being intubated.

[Here.I.Stand, BSN, RN]

Jensmom, sometimes we do have pts who are not sedated, but only if they have a RASS of 0 or less and not impulsive.

[KatieMI, BSN, MSN, RN]

I don't know, I was intubated when I coded after an anaphylactic reaction and I wasn't sedated. I know this was probably an exception.

Of course, it was a community hospital and we all knew each other. My nurses told me I could have sedation if I needed it, but I never did.

Frankly, the NG tube annoyed me more than being intubated.

Nope, you are not!

Anaphylaxis is not surgery, the edema usually goes down pretty quickly, so the goal is to get tube out and patient active ASAP. Honestly, I want the same thing. So, I put on my medical alert note "keep sedation minimal" and two last times that was done and it turned out as great as anaphylaxis with tube can possibly be. Out of hospital within 48 hours or less:up:

Restrains are ok, though. That tube, NG and that Foley are all irritating like (you know what).

[CrazierThanYou]

I would write an incident report. Our postops are frequently brought up unsedated and unrestrained.........because paralytics are still on board. (We just know sedation is a priority once ICU orders are in.) None of this needing to hold people down. Also, the CRNA always calls report. Did either anesthesia or OR RN come with the pt to give a bedside report? If not, not cool.

Paralytics weren't still on board with this one. I got a little bit of report from anesthesia on vital signs and such but not much of a real report. It would have been nice to at least have a heads up that the patient was headed my way!

[Rose_Queen, BSN, MSN, RN]

Way back when I was in nursing school, I had a patient who was intubated. He'd be sitting in bed doing crossword puzzles like the tube didn't bother him at all. Yes, endotracheal tube. Zero sedation. Not a fresh postop though.

I have had some patients that I've taken from the OR to the ICU who would start coming around in the elevator during transport. Anesthesia does have emergency drugs including a syringe of propofol if needed. Sometimes we use it, sometimes we don't if the patient is a fast track to extubation and mobilization.

[RNperdiem, RN]

In an ideal world, anesthesia would give you a call when the patient is being moved. That way you can have the respiratory therapist and an extra nurse ready when the patient arrives.

A patient arriving wild is not common. Anesthesia usually gives them a touch of sedation for the road. This gives you time to get restraints and ask your doctors about plan for extubation. If the patient is going to stay intubated, you can ask for a plan for sedation.

People vary. I have patients who are awake, vented and texting away on their phones while others go absolutely wild with any weaning of sedation.

[blondy2061h, MSN, RN]

I would write an incident report. Our postops are frequently brought up unsedated and unrestrained.........because paralytics are still on board. (We just know sedation is a priority once ICU orders are in.) None of this needing to hold people down. Also, the CRNA always calls report. Did either anesthesia or OR RN come with the pt to give a bedside report? If not, not cool.

If they have paralytics on board, that's all the more reason sedation is need. That's just cruel.

[meluvsquki]

I work in pediatrics so things might be a little different but our practice is such:

Anesthesia will give you report ahead of time, telling you patient's access, airway, any drains, etc. Then they bring the patient up with their little sedation bundle, which usually includes bolus doses of fentanyl, versed, paralytics, etc. They are almost always calm and well sedated when they first arrive in the ICU. When they're not, anesthesia will usually give a PRN before they leave. Anesthesia sticks around for 10, 15 minutes after patient arrives to give report to the team and to make sure patient is stable right after transport. We've had kids who wake up too soon with a bang, and a lot of times the sedation drips don't come as fast as we'd like it to, so in the mean time we do our best to keep the patient calm with PRNs. Also, we always keep restraints in the room before patient arrives if we find out that the patient is intubated. What happened to you is most certainly not safe and is reportable.

[OCNRN63, RN]

If they have paralytics on board, that's all the more reason sedation is need. That's just cruel.

Amen. Sounds like a nightmare to me.