Friday, April 6, 2012
To Restrain or Not To Restrain
Last night I kinda got into it with a co-worker, one of the RT's. She decided to pick a bone with me about one of my patients from last week. The fellow was intubated and lightly sedated but able to follow commands and was pretty alert. According to my orders I was not to sedate him any further nor could he take it hemodynamically, when they increased sedation he would brady down into the 40's.
Anyhow the bone the RT had to pick with me was the fact that my patient spent the entire night unrestrained and in the morning extubated himself about an hour before shift change. Her point was that EVERY intubated patient should be put in restraints and thus my patient should have been in two point soft restraints.
My issue with her point of view was this, the fellow never made a single move for that tube all night. In fact he acknowledged that he understood the purpose of it and even kept his hands at his sides or crossed across his tummy. I always understood that to initiate an order for restraints your patient had to be actively pulling at stuff or demonstrating in some way that he is going to yank at something. I don't have a problem restraining patients, when it is warranted, and I didn't think that being intubated and vented is an indication for restraints otherwise every order set for my intubated patients would include a restraints order.
Well anyhow the talk I had with her didn't really get much past how she was right because the guy did extubate himself and that I was stupid to think that he didn't need to be restrained. I personally feel that I did the right thing ethically and legally to not restrain him as he gave me no evidence to believe it was necessary, it's not to say that I didn't go home that morning and cry my eyes out feeling like a total failure. I had a few days to deal with it and then I get this...a whole fistful of salt in the wound. Great.