RESTRAINTS & ITS TYPES

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.
DEFINITIONS

Restraint is defined as ‘the intentional restriction of a person’s

voluntary movement or behavior.
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
INDICATIONS

✦ Displaying behavior that is putting themselves at risk of harm

✦ Requiring treatment by a legal order, for example, under the Mental
Health Act 2007
✦ Requiring urgent life-saving treatment
✦ Needing to be maintained in secure settings
PRINCIPLES

• Select the safe and appropriate restraint

• Restraint should not be too tight; it should not interfere with the
normal circulation
• Always maintain comfort to the child and maintain body alignment
• Do not give too much tight knot. Should be able to quickly release the
device
• Observe the restraint every 20-30 minutes to prevent any
complications
• Should be removed a minimum of every 2 hrs.
• Do the recording and reporting properly
TYPES OF RESTRAINTS

1. Physical restraints

• The use of a manual hold to restrict freedom of movement of all or

part of a person's body, or to restrict normal access to the person's
body,
2. Environmental restraints
• That change or modify a person’s surroundings to restrict or control
a client’s mobility. E.g. A secure unit or garden, seclusion
3. Chemical restraints
• Are any form of psychoactive medication used not to treat illness,

but to intentionally inhibit a particular behaviour or movement

Physical restraints
• Mummy restraint
• Elbow & Knee restraint
• Extremity restraint
• Abdominal restraint
• Jacket restraint
• Mitten or finger restraint
• Crib net restraint
• Safety Belt
Mummy restraint
PURPOSE

To Immobilize of arms & legs for long period of time.

During Examination & Treatment of head & neck

During puncture of jugular vein

During gastric gavage & lavage

 Modified mummy restrain may be used when the child’s chest to be examine
Elbow & Knee restraint
PURPOSE

• To keep of the elbow in extended position so infant can not reach the face

after the surgery of the child’s face & head such as cleft palate repair
• During in Eczema & skin disorder
• When introduce of the scalp vein
Extremity restraint
PURPOSE
 To immobilize one or more extremities same as elbow restraint
 In these restraint chance to cutting of circulation so restrained extremities
should be examine for coldness and discoloration
Uses :
 To keep one or both extremity restrained or limited in motion.
Age group:- Neonate/infant/toddler/pre- schoolers
Jacket restraint
PURPOSE

• To help of the baby remain flat in bed in a supine position

• To prevent of the baby falling from high chair

• To prevent of the baby up down on cribs
• Chance of strangulation with jacket restraints
Abdominal restraint
PURPOSE

• To maintain supine position

• Keep in mind that child respiratory movement of the abdomen are not
inhibited
Mitten or finger restraint

 Used for infants to prevent self injury by hands in case of burns, facial injury or
operations, eczema of the face or body.

 Mitten can be made wrapping the child’s hand in gauze or with a little bag
putting over the baby’s hand and tie it on at the wrist.

 Age group:-Neonate/infant
Crib net restraint

 If the infant or toddler is capable of climbing over the crib sides, a crib net or
plastic dome may be used to keep the child safely in the bed

 Crib net should be tied to the frame. The knot used must be of the type that can
be untied quickly in case of an emergency
Safety Belt
• Car seat / seat belt can be considered as a restraint.
Other safety devices:

• Side rails
• Grab bars
• Ambu alarms
• Non-skid slippers etc..
Side rails and splints

• A small low bed for an infant or a younger child must have high side rails as a
restraint, to prevent falling from the bed.

• Age group:- Infant/toddler/younger child

Grab Bars
Uses and Benefits of Having Grab Bars in Hospitals
• Prevention of Injuries: Grab bars help prevent falls and other
related injuries.
• They are especially beneficial in the bathroom, by the bedside, and
in other slippery or potentially hazardous areas.
Ambu alarms
• To combat this risk, alarm systems such as bed alarms or chair alarms
are often used to alert nursing staff when at-risk patients attempt to get
up without assistance.
Non-skid footwear
• Is characterized by a slip-resistant bottom.
• Even when walking on wet or otherwise slippery floors, you won't
lose traction.
• Non-skid footwear will "grip" the floor so that you don't slip and fall.
Nurses Role

Monitor a patient in restraint every 15 minutes for:

• Signs of injury
• Circulation and range of motion
• Comfort
• Readiness for discontinuation of restraint
DOCUMENTATION IN 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