I am a believer in wrist restraints on all sedated patients. All patients can and will wake up and pull their ETT without realizing what they are doing. If a patient is cooperative and not sedated then no restraints can be considered. The tramatic brain injury patients would get "mitts" instead of restraints. We frequently don't use restraints, due to the objection of some of our nurses. I have to retape or reintubated more then I am used to doing at other hospitals. I would like to hear what the rest of the country is doing. Please comment on this post and please add a response to the poll that I have posted.

Thanks,

GJ

Depends on the patient. If your talking post anesthesia where a recuperating patient is expected to rouse then nursing should be prepared to intervene as needed. If your describing a person under sedation treatment then perhaps restraints are in order. If that patient has a combative history or would be medically intolerant of reintubation then by all means restrain. I don't want restraints to take the place of understaffing.

I agree that it is very patient dependent.

I find that in our ICU we are using restraints less than we were a few years ago. I think this is due to the implementation of sedation/agitation scale usage and daily review in our ICU. We currently use the Richmond agitation sedation scale (RASS).

Also, in Canadian ICUs restraints must be ordered daily and can only be ordered by the staff physician. This supposedly stems from a critical incident that happened somewhere.

The Country is trying to go "Restraint Free" there are other options, but the problem arises with semi-sedated patients and patients with poor cognition.
We have tried using the gambit of alternatives on the market, but I have found one of the best things to do is not use light sedation and use proper pain control.
I have been intubated and on a vent and light sedation really messes with your head and reality, but my pain was still there.
Also if we treat the anxiety issue and not snow them out it helps in the long run for weaning purposes.

One thing I find useful is knee immobilizers on elbows. They can flail all they want, but cannot yank on any tubes