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RESTRAINTS

INTRODUCTION
Children may need to be restrained for
some diagnostic procedures, therapeutic
procedures or during the physical examination
and sometimes to protect from an injury

An appropriate safe and comfortable restraint


should be selected. The restraint may be
provided manually with help of some device
PURPOSE
To carry out the physical examination

To provide the safety to child

To protect the child from injury

To complete the diagnostic and therapeutic


procedures

To maintain the child in prescribed position

To reduce the discomfort of child during some


tests and procedures like specimen collection
ARTICLES NEEDED
Baby blanket or draw sheet
4” bandages for clove hitch knot
Cotton pads
Restraint cloths with pocket
Wooden plastic sticks (spatula) to keep
in for elbow restraint
Scissors to cut the bandage
Jacket for jacket restraint
Adhesive tape to fix the bandage
POINTS
TO
REMEMBER
WHILE
RESTRAINING
Always select the safe and appropriate restraint

Restraint should not be too tight; it should not


interfere with the normal circulation

Use appropriate cotton pads for maintaining the


comfort of child

Restraint should demonstrate to the child, on the


child doll to gain the cooperation and reduce the
anxiety

Explain the restraint and it to comportment that


the child should be able to understand
Always maintain comfort to the child and
maintain body alignment

Open the restraint knot, when the side rails


are eased to prevent traction

Observe the restraint every 20-30 minutes to


prevent any complications
Change the side of child to prevent pressure
sore

Do not give too much tight knot. It should


be easily releasable

Do not provide purposeless restraining

Do the recording and reporting properly


TYPES
OF
RESTRAINING
Mummy restraint
Mummy restraint is used for the children to
restrict the moment of limbs

It is used to the children for examination,


procedure and treatment of head, neck and
face is required

For example like scalp vein puncture, ear


examination, and eye irrigation, gastric and
gastric lavage
PROCEDURE

Take blanket or draw sheet and spread it our the bed


or table

One corner of a small blanket is folded over

The infant is paced on the blanket with the neck at


the edge of the fold

Keep one hand of baby near the body and wrap the
baby,s body by holding the corner of the sheet and
tuck it under the body in opposite side
Now place another hand near the body and wrap
the childs body by holding another corner of sheet
and tuck it

Now take the rounded sheet at bottom near the


leg and fold it towards the chest and tuck it upper
level of sheet or we can pin it at lower of sheet

It restrict all extremities


ELBOW AND KNEE RESTRAINT

Elbow and knee restraint is used to


control the flexion of elbow and knee

In this a readymade cloth with 6-10


pockets is used

Place the cotton on sides of elbow and


knee and the knee the wooden or plastic
strips on pocket cloth. These pockets are
vertical
Place the cloth on elbow and knee and
adjust it with central location and tie the
both side strips properly

This elbow restraint is used in case of face


and head surgeries

Cleft lip and cleft palate, scalp vein


infusion, heart injuries and sutures are
good examples of using this elbow
restraint
ABDOMINAL RESTRAINT

This restraint is used to hold the infant in a supine position


on the bed

Abdominal restraint should not be too light, so that it


cannot interfere with respiration and bowel movement

For this restraint, use wide size wooden strips


Place the cotton pad appropriately to provide the proper
comfort
Extremity Restraint (Ankle & Wrist restraint)

This involve the extremity (one or more)


restraint to complete some procedures

It is used to immobilize the extremities

These are various method uses for ankle and


wrist restraint
CLOVE HITCH KNOT RESTRAINT

It used to immobilize the leg or arm

The material for clove hitch can be soft cloth,


crepe bandage and inch wide gauze bandage

First apply the cotton pad over the wrist,


ankle to provide comfort
Prepare a figure of “eight” by the bandage and
place it on the wrist or in the ankle and tie the
bandage by knot

Knot should not be too tight, or too loose

Child can remove the knot, if it is too loose

To tight knot can interfere on blood circulation

The fingers and toes should be checked for


discoloration or any skin rashes
Finger Restraint
It can be completed by making a mitten

The mitten course the all fingers of a hand and restrict


the movement of the fingers

The hand can be wrapped by gauze or hand can be put in


a bag like pouch and tie it properly at the wrist of child

Finger restraint is used in case of facial surgeries, burns,


intravenous infusion, any eczema of face and body parts

Keep the mitten soft and it should not interfere


circulation
Crib-net restraint
In this a net is used to cover the child cot

Net is attached to the cot frame

This net restraint is used to prevent the children climbing


over the side rails of cot

Inside the crib net, the child is totally free to move, no


movement is restricted

It mainly prevents the child to climb and fall from the


side rails cot
Jacket Restraint

In this method, a jacket made up of soft cloth and leather is


used

This jacket has laces at the back and two long strips

The laces are tied at back and long strips tie at the side
below the rails under the mattress

Child can sit and sleep in supine position while wearing


jacket

It can use on chair also


This restraint is used to avoid the child from climbing
over the side rails, climbing out from chair, bed, cot, etc.

It prevent the child from fall and injury

Some other types eg. Chest restraints are also used for
children who are sitting on a chair or wheel chair to
maintain their position and to prevent them from fall
and injury
Safety Belts
These are made up of electrically non-conductive
material

These belts are used on stricter and operation


labels to prevent the children from falling

The belts go around the childs waist and tied to the


frame of bed under the mattress
Side Rails
The rails are made up of iron or steel

These can be raised when ever need arises


and can be decreased as per convenience

The main purpose of side rails are to


prevent from fall and can be used for other
restraints.

These are used for children with convulsive


disorders also
Splints
These are prepared devices which are used to
restraint the movements of extremities

These are made up of plastic, card board, hard


paper, and cotton and gauze pieces

These can be applied where ever needed


COMPLICATIONS
OF
RESTRAINTS
If restraints are not used properly, it can cause various
complications or hazards

It can interfere the child muscular development due to lack


movement

If restraint is too tight, it cause obstruction in blood


circulation tissue damage, redness, scar formation,
discoloration of the skin etc

Dislocation of the shoulder joint may occur if the child


struggles during application of arm restraints

Development of pressure sore, if the child is kept restricted


for longer period of time and does not have frequent change
of position and skin care

Hypostatic pneumonia due to immobility


Ischemia or nerve damage due to constrictive restrains

Psychic injury to the child, the child feels that, he/she is punished,
attention is self body image

Disturbance in psychosocial development

To avoid from these hazards, the care giver or nurse should follow the
safety precautions

Use proper amount of cotton pads, and do not use too tight restraint

Always follow continuous observation on child

If any application occurs release the restraint and consult with doctor

Maintain proper recording and reporting

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