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American Journal of Critical Care. 2008;17: 408-415
Copyright © 2008 by the American Association of Critical-Care Nurses.
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CE Article

Influence of Physical Restraint on Unplanned Extubation of Adult Intensive Care Patients: A Case-Control Study

By Li-Yin Chang, RN, MSN, Kai-Wei Katherine Wang, RN, PhD and Yann-Fen Chao, RN, PhD. Li-Yin Chang is supervisor of the nursing department at Taichung Veterans General Hospital and is a doctoral student in the School of Nursing, National Yang-Ming University, Taipei, Taiwan. Kai-Wei Katherine Wang is an assistant professor in the School of Nursing at National Yang-Ming University, Taipei, Taiwan. Yann-Fen Chao is a professor in the College of Nursing at Taipei Medical University, Taipei, Taiwan.

Corresponding author: Yann-Fen Chao, RN, PhD, College of Nursing, Taipei Medical University, 250 Wu-Xin St, Taipei City, Taiwan 110 (e-mail: yfchao.tw{at}yahoo.com.tw).

Background Unplanned extubation commonly occurs in intensive care units. Various physical restraints have been used to prevent patients from removing their endotracheal tubes. However, physical restraint not only does not consistently prevent injury but also may be a safety hazard to patients.

Objectives To evaluate the effect of physical restraint on unplanned extubation in adult intensive care patients.

Methods A total of 100 patients with unplanned extubations and 200 age-, sex-, and diagnosis-matched controls with no record of unplanned extubation were included in this case-control study. The 300 participants were selected from a population of 1455 patients receiving mechanical ventilation during a 21-month period in an adult intensive care unit at a medical center in Taiwan. Data were collected by reviewing medical records and incident reports of unplanned extubation.

Results The incidence rate of unplanned extubation was 8.7%. Factors associated with increased risk for unplanned extubation included use of physical restraints (increased risk, 3.11 times), nosocomial infection (increased risk, 2.02 times), and a score of 9 or greater on the Glasgow Coma Scale on admission to the unit (increased risk, 1.98 times). Episodes of unplanned extubation also were associated with longer stays in the unit.

Conclusions An impaired level of consciousness on admission to the intensive care unit and the presence of nosocomial infection intensify the risk for unplanned extubation, even when physical restraints are used. To minimize the risk of unplanned extubation, nurses must establish better standards for using restraints.

Notice to CE enrollees:
A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
  1. Describe the role of physical restraint in unplanned extubation.
  2. Recognize nursing- and patient-related factors that increase the risk of extubation.
  3. Review the study presented to evaluate its usefulness for clinical practice.
To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue." No CE test fee for AACN members.


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