Preventing Self-Extubation Without Using Restraints

Q We are trying to be a restraint-free unit, but when a patient constantly reaches for their endotracheal tube, it is tempting to apply restraints. What other strategies can we use to prevent self-extubation?

A Michele C. Balas, PhD, RN, CCRN-K, and Audrey Brockman, BSN, RN, CCRN, reply:

Physical restraints play a highly controversial role in the care of critically ill patients. Proponents contend that physical restraints are necessary to protect patients from the harm associated with self-extubation, accidental device removal, and falls, and that they prevent injury to health care staff if a patient should become combative or physically aggressive. However, prior studies exploring physical restraint use and outcomes among critically ill patients do not support this belief; many paradoxically report that physical restraints are actually associated with higher rates of the adverse events that their use is intended to prevent.¹  Opponents argue that, in the absence of...