have you used chemical restraint?

[diamondmeadows]

Hello! :flowersfo

I am interested in hearing about your experiences with using chemical restraint in your practice. Have there been times when you have had a PRN order for Ativan, Haldol, or some other drug, and you used it to chemically restrain a patient? Researchers report that nurses state that they do so for many reasons, ranging from preventing patients from interfering with necessary treatments to keeping patients from wandering to quieting demanding patients when the unit is understaffed.

I am working on a presentation about this subject for my nursing ethics class, and I have been reading journal article after journal article. At this point, I feel that it would help to hear from some real nurses with real experience. I am expected to discuss pros and cons of this issue, so I would love to hear your thoughts, opinions, and personal stories about this subject whether you have used chemical restraint or not. With your permission, I would like to use some quotes for my presentation with absolutely no identifying data. I will not even say that it is from allnurses. If you don't want me to quote you, just say so! I still want to hear from you. Please feel free to PM me if you feel more comfortable doing so.

Thank you all!

[wjf00]

Vecuronium on an intubated pt to prevent extubation. Pt was severe PPHN on iNO who would expired in minutes if accidentally extubated. Considering the difficulty of reintubation and the likely inability to effectivly deliver the iNO by bag and mask, the physician ordered Vecuronium for paralysis. Given the circumstances it was entirely appropriate. The parents were consulted first, and they insisted everything be done. The patient eventually was made no code, and expired quickly after extubation. Never before or since have I given that med.

[BlueEyedRN]

Vecuronium on an intubated pt to prevent extubation. Pt was severe PPHN on iNO who would expired in minutes if accidentally extubated. Considering the difficulty of reintubation and the likely inability to effectivly deliver the iNO by bag and mask, the physician ordered Vecuronium for paralysis. Given the circumstances it was entirely appropriate. The parents were consulted first, and they insisted everything be done. The patient eventually was made no code, and expired quickly after extubation. Never before or since have I given that med.

That reminds me of a time we used vec on a patient with a GI bleed who refused blood transfusions. Her Hgb was so low (less than 3 at one point), that the intensivists decided to paralyze her completely to reduce o2 utilization. So I guess it was a restraint since we used it so she couldn't move a muscle.

[RockyCreek]

Years ago, I had a gigantic, athletic man admitted to the ICU intubated and paralysed (Pavulon). He presented to the ER with a grossly broken nose and raging ETOH intoxication. The resident on duty, after nearly being clobbered a few times 'chemically restrained' him only to have him stop breathing. We kept him on the ventilator for nearly 12 hours while he 'slept it off.' Needless to say, there was an immediate reminder to all the house staff about the appropriate and inappropriate use of paralytics!

[EarthChild1130]

I have frequently used chemical restraints, alone and in conjunction with physical restraints...having worked inpatient psych, it is a necessity every so often...you can only stand so many chairs being thrown over the nurse's station at ya!

We used IM Haldol, Benadryl, and Ativan on most people...sometimes IM Zyprexa. If someone was starting to escalate, we would first try to get the person to take whatever oral PRN was ordered to calm them down, and have them go to their room to calm down/reduce stimuli...if that didn't work and they became extremely agitated/aggressive/dangerous, we went to more potent chemical restraints...in the end, one of my functions on inpatient psych is to keep everybody safe and alive until morning...

[mabs21676 LPN]

Working in a Nursing Home, Even when you have a Doctor order to use Ativan IM: there is still guidelines & protocols You have to address. Try to help the resident in other ways first. check to see that they are clean and dry, see if they are hungry or thirsty, pain management. danger to self or others. Check VS before giving and each hr. after giving X 3. All this takes up a lot of time when a nurse is already busy. I work nights, but we are kept at a steady pace to get everything done. checking all incoming orders from days/evenings and placing these where they go. doing Resp Tx, inhalers, eye gtts, meds, dextrostick, puting up meds, filling new Narc sheets.staffing book as well as signing MAR & Tx MAR., checking Daily Care, glu machine, Insulin. Everything that can be put on for the night shift to do to take extra work off days/evening nurses.

The other night, I had a sitter call family on me because I would not give resident Ativan "shot" so she will go to sleep. Was told she is upset & aggitated. When I ask how. sitter stated she is not sleeping and is singing. GOSH Explain it is her room and as long as calm and not danger to self that I could not give "shot" when the son came ask if she need Activan and I explained calm and doesn't need it. He went to room and came back. Stated No she doesn't need it. Can You give her a sleeping pill. She's not herself, but she doesn't need Ativan. And I am a little afraid for her to have it again. The other day after taking it she was really out of it and slept alot. But I'll talking to the Dr. about all this in the AM. And we won't call it a "shot" anymore.This resident was able to sit up in recliner talking/singing for another hr, then sleepy and ready for bed. No further problems. Didn't need the Ativan and it should have already been D/Ced. if Family was concerned about her taking it again.

This is more than what You ask for, but I hope it may be of some use.