Tuesday, January 15, 2008

¡Átame! or Atase, I don't know Spanish that well

Today was the second day of orientation at my new job. I now have health insurance, a 403(b)like a 401(k) for non-profits, and no vacation/sick days for three months. Oh, and an understanding of the standards of nursing practice. The important stuff is what I'm saying. We also practiced putting restraints like these on and tying quick-release knots.

Depending on your sense of humor or kink factor, these might seem mean/sad, adorable (that second one is called a mitten), or stimulating. Well you're all wrong. Hee. Restraints are necessary equipment to prevent patients from doing dangerous things like pulling out tubes and wires. Being ill or injured in the hospital can be disorienting and things sticking into your arms, chest, nose, mouth, etc. tends to be uncomfortable at best. When a patient is not all there and some bit of medical equipment is bothering them, they often pull at them.

I was caring for a patient once that grabbed his Foley catheter (that's the tube that drains the bladder) and pulled so that the tube sheared off where it was taped to his leg. He was lucky. Foleys stay in place because there's a balloon at the end that's inflated with saline to anchor it in the bladder. If the tubing hadn't sheared, he might have managed to pull the balloon THROUGH HIS URETHRA. Yeah. It's happened. The penis maybe doesn't work so well after that kind of trauma.

Restraints are also necessary for even calm, oriented patients if they are intubated (tube down the throat to maintain airway), with or without a mechanical ventilator attached. Cause everything can be fine and dandy, they're writing messages for you, participating in their own care, and then they get a little irritation, start to cough, and the first thing they do is grab the thing sticking down their throat and pull it out. Since the endotrachial tube has a cuff that's inflated to hold it in place below the vocal cords, pulling it out damages the cords badly. So possibly no more talking. And then there's the problem of the patient no longer having a patent airway. Bad stuff.

In conclusion, restraints are often necessary and very much therapeutic despite the initial image of tying a patient down against their will. I realize now that this isn't the cheeriest of topics, though to be it's just part of the job. Uh, just be happy I didn't link to a video of a Foley catheter insertion? Unicorn chaser?

1 comment:

  1. I looked at the unicorn chaser and all I could think about was that HORN GOING THROUGH MY URETHRA! I hate you sometimes.