Yeah, it definitely is tricky. I don't know what setting you are practicing in, but in LTC, it is almost impossible to get a facility to understand the need. But, for peripherals in the forearm, you can try wrapping in in kling then placing a long sleeve, buttoned shirt. (Just make sure the site is still being assessed) Catheter securement devices help too, but in reality, if a patient is pulling, he or she will get to it regardless of the obstacles. At times, we must look at the cultures to determine if another drug can work which can go another route, or should the patient be hospitalized where it may be easier to carry out restraint orders... and lastly, can anyone say, chemical restraints..LOL
Tough problem. I have always worked from "out of sight out of mind". HIding the IV set and wrapping the arm with a roller bandage from the IV hub downward. I know the issue with roller bandages, but this would prevent the patient from getting their fingers in the loop of extension set or working on part of the dressing. This would have to be done carefully though so that the site is visible from puncture upward. I hesitate to use a roller bandage and would never recommend it except for this type of patient. Then again with some patients, this bandage could give them more to pull at. Not an easy patient to manage. Lynn
One other thought - a sitter to watch patient, prevent this by engaging them in other activities. I do like the idea of considering changing the route of therapy if possible. Maybe changing IV to PO. Lynn
for the confused patients I KNOW are going to get right to work on removing a piv, the goal is "out of sight out of mind". I try to place the line on the outer forearm if possible. Proximal locations work better too because the iv tubing can be anchored away from their hands. Then I add layers depending on how dedicated the patient is to iv removal.
A large tegederm over the j-loop prevents the tubing from getting caught and pulled. It the patient has very fragile skin, it helps to put something between the skin and tubing before placing the large tegederm. Surginet is my next layer of choice, then if possible a button cuff shirt sleeve. Tube guaze (tubigrip) is useful in a size small enough to stay in place while not applying pressure. I've seen nurses apply coban and it makes me want to scream, but in an extreme case I would very loosely do a couple wraps. Emphasis on very loosely.
Hopefully these patients have frequent monitoring that includes iv assessment. Sometimes getting them through a shift with an intact iv is an accomplishment!
We just rolled out "busy aprons" which help the twiddlers. Prior to these I would loosely secure dummy IVs for the patient to play with and then hide my true IV.
Yeah, it definitely is tricky. I don't know what setting you are practicing in, but in LTC, it is almost impossible to get a facility to understand the need. But, for peripherals in the forearm, you can try wrapping in in kling then placing a long sleeve, buttoned shirt. (Just make sure the site is still being assessed) Catheter securement devices help too, but in reality, if a patient is pulling, he or she will get to it regardless of the obstacles. At times, we must look at the cultures to determine if another drug can work which can go another route, or should the patient be hospitalized where it may be easier to carry out restraint orders... and lastly, can anyone say, chemical restraints..LOL
Tough problem. I have always worked from "out of sight out of mind". HIding the IV set and wrapping the arm with a roller bandage from the IV hub downward. I know the issue with roller bandages, but this would prevent the patient from getting their fingers in the loop of extension set or working on part of the dressing. This would have to be done carefully though so that the site is visible from puncture upward. I hesitate to use a roller bandage and would never recommend it except for this type of patient. Then again with some patients, this bandage could give them more to pull at. Not an easy patient to manage. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
One other thought - a sitter to watch patient, prevent this by engaging them in other activities. I do like the idea of considering changing the route of therapy if possible. Maybe changing IV to PO. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
for the confused patients I KNOW are going to get right to work on removing a piv, the goal is "out of sight out of mind". I try to place the line on the outer forearm if possible. Proximal locations work better too because the iv tubing can be anchored away from their hands. Then I add layers depending on how dedicated the patient is to iv removal.
A large tegederm over the j-loop prevents the tubing from getting caught and pulled. It the patient has very fragile skin, it helps to put something between the skin and tubing before placing the large tegederm. Surginet is my next layer of choice, then if possible a button cuff shirt sleeve. Tube guaze (tubigrip) is useful in a size small enough to stay in place while not applying pressure. I've seen nurses apply coban and it makes me want to scream, but in an extreme case I would very loosely do a couple wraps. Emphasis on very loosely.
Hopefully these patients have frequent monitoring that includes iv assessment. Sometimes getting them through a shift with an intact iv is an accomplishment!
We just rolled out "busy aprons" which help the twiddlers. Prior to these I would loosely secure dummy IVs for the patient to play with and then hide my true IV.
~ Kathleen