I was recently taking care of a patient with hypoxic brain injury. He was extubated (breathing on his own), so we were unable to sedate him to control his restless behavior. When I say “restless”, it’s an understatement. He was flailing so much in the bed, that his arms were doing windmills up in the air, hitting anyone and anything within striking distance. He wasn’t conscious, so he wasn’t doing it to intentionally harm anyone, it was just his reaction to any sort of stimuli in his room.
It was my second day in a row taking care of him and I was physically and mentally worn out. It’s a lot of work to reposition someone in the bed every 20 minutes because they are about to fall out of the bed or laying so crooked that their head is hitting the railings. One of the phlebotomists walked in the room to get a blood sample (the nurses were usually drawing blood samples from his central line, but our policy is for one set of blood cultures to be drawn directly by venipuncture by the lab staff). She gets ready to check his veins and he starts flailing, just as I warned her he would do. I was holding his arm down to the best of my ability, but it still shook a little. Then, she says “isn’t there something you can do about this? It’s making it really hard for me to do my job.” Wow. Really, lady? It’s making it really hard for ME to do my job too. I was about 18 hours deep with this patient… and she only had to be there for about 10 minutes. I wanted to tell her how hard it was to just do an assessment – listen to his lung sounds, check his pupils, assess pulses in his feet, or give medication down his feeding tube, or heck, even irrigate his rectal tube. Every single thing I’ve done over the last 18 hours has been difficult.
I know that she’s not used to being around these patients as much as we, as ICU staff, are but I would think there would be a little bit of understanding for the situation. If I could give the patient a magic medication that would make him calm, while allowing him to continue breathing and allow us to continue monitoring his mental status, I would give it in a heartbeat.
Uhhh… exhausting.
Which is why I am thankful that our PCA’s (CNA’s/techs) draw any non-central line labs needed. It is nice not having to call the lab when we need a peripheral blood draw.
Jeff
JeffTheRn’s Email Address
That would be amazing! (although we dont have techs in our unit, so it’s us, the respiratory therapists, and then everyone else outside of the ICU)
oh dear, how difficult! Neuro pts are my most dreaded ones. Kicking, screaming, getting naked, it makes for a busy day!
I love when the doc’s round and come out to say “I think he needs to be repositioned in bed” – as if you weren’t taking care of the pt at all.
SIGH
Exactly! Or when a doc comes by and says “You know the head of the bed needs to be at 30 degrees, right?” after the patient has slid down in the bed for the 40th time in the last hour.
All I have to say is: HALDOL is heaven when Ketamine and/or Vec are not an option!!