PHYSICAL RESTRAINT IN ICUMandira Dahal, RNGrande International Hospital

Restraint

Device or protocol for restricting mobility of patient.– slide rails that restrict patient’s movement and pt.

cannot remove rails– chairs– head / limb immobilization devices– seclusion where pt. cannot leave– etc.– [Medical / pharmacological restraints]

DEFINITION OF PHYSICAL RESTRAINT

• Any manual method or physical or mechanical devices ,material or equipment attached or adjacent to a patient’s body, that he or she cannot easily remove, that restricts freedom of movement or normal access to one’s body’.

Types of restraints Soft Soft

wrist/anklewrist/ankle Straps/beltsStraps/belts Two- three- or Two- three- or

four-pointfour-point Wheelchair Wheelchair

safety barssafety bars

MittMitt Chairs with Chairs with

lapboardslapboards Beds with Beds with

siderailssiderails BedsheetsBedsheets Vest/jacketVest/jacket

Purpose of `Restrain

RISK and Side Effect.

Psychological/Emotional:Increased agitation, hostility, aggression and combativenessFeelings of humiliation, loss of dignityIncreased confusionFearPhysical:Pressure ulcers, skin trauma (tears, cuts, bruises)Physical discomfort, increased painIncreased constipation, increased risk of fecal impactionIncreased incontinence and risk of UTI Obstructed and restricted circulationReduced appetiteDehydration

Alternatives restraints Strategis.

• Alternative methods– Diversional activities – TV, radio, reading, games,

ambulation– Provide information to alleviate fear– Interaction by family member, child life or volunteers– Collaborate with medical staff to change treatment

plan if indicated– Environmental changes – reduce noise, call light with

in reach, change lighting within room.

Patient and Family Education:– Discuss with patient and family safety

concerns, i.e. risks of pulling out IV.

– Explain the behavior that initiated restrain use.

– Explain the alternatives tried.

– Assure that safety/comfort will be met

Monitor a patient in restraint every 15 minutes for:

• Signs of injury

• Circulation and range of motion

• Comfort

• Readiness for discontinuation of restraint

Documentation (on the restraint management flow sheet) every 2 hours for:

• Release the patient, turn and position

• Institute a trial of restraint release

• Hydration and nutrition needs

• Elimination needs

• Comfort and repositioning needs

Correct way to tie a quick –release knot.

To make a quick-release knot, make a regular over hand knot, but slip a loop (instead of the end of the strap) through the first loop.

Reminder- on restraints• Remember not to tie to side rails or cross

behind the patient.

The View from the Ethical Window

Protect the Patient’s Rights

Benefiecience Autonomy and Respect

Fidelity Equality

Justice Dignity