![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]](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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physical restrain in ICU
- 1. PHYSICAL RESTRAINT IN ICU Mandira Dahal, RN Grande International Hospital
- 2. 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]
- 3. 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’.
- 4. Types of restraints Soft wrist/ankleSoft wrist/ankle Straps/beltsStraps/belts Two- three- orTwo- three- or four-pointfour-point WheelchairWheelchair safety barssafety bars MittMitt Chairs withChairs with lapboardslapboards Beds withBeds with siderailssiderails BedsheetsBedsheets Vest/jacketVest/jacket
- 6. RISK and Side Effect. Psychological/Emotional: Increased agitation, hostility, aggression and combativeness Feelings of humiliation, loss of dignity Increased confusion Fear Physical: Pressure ulcers, skin trauma (tears, cuts, bruises) Physical discomfort, increased pain Increased constipation, increased risk of fecal impaction Increased incontinence and risk of UTI Obstructed and restricted circulation Reduced appetite Dehydration
- 7. 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.
- 8. 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
- 9. Monitor a patient in restraint every 15 minutes for: • Signs of injury • Circulation and range of motion • Comfort • Readiness for discontinuation of restraint
- 10. 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
- 11. 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.
- 12. Reminder- on restraints • Remember not to tie to side rails or cross behind the patient.
- 13. The View from the Ethical Window Protect the Patient’s Rights Benefiecience Autonomy and Respect Fidelity Equality Justice Dignity
Editor's Notes
- Soft wrist and ankle restraints. Straps and belts are used in a similar fashion as a vest restraint, but are less restrictive in movement. The belt wraps around the waist and is secured to a chair or bed. Two-, Three- or Four-point wrist and ankle restraints. The number designates how many extremities are being restrained. For example, the two-point restraint would only restrict movement on the wrists. Wheelchair safety bars. Mitt restraints cover an entire hand and fingers typically go in one of the five inside pockets unless the hand could be grasping a towel inside the restraint. Chairs with lapboards. Beds with siderails, and bedsheets. Vest and jacket restraints always cross in the back of a person and are applied to the chest. This confines a person to a bed or chair and prevents them from moving. These restraints carry the greatest risk to life since if a person tries to get out of the position they are confined in, they can become strangulated and die.
- Prevent falls and protect the patient from harm. Studies found that the most common reasons nurses gave for applying physical restraints focused on patient protection and fall prevention. Prevent interference with medical treatments such as self-extubation. It has been argued that self-extubation, in and of itself, should not be regarded as a morbid event and that 63% to 89% of self-extubations do not require reintubation.[1],[2] In fact, it is critical to frequently reassess a patient’s suitability for early extubation because it may eliminate the source of the patient’s agitation, which is the major reason health care providers restrain patients. To protect medical devices such as IV lines, indwelling urinary catheters, NG-tubes, dressings and other forms of drainage easily accessible to the patient. Decrease legal liability and family pressure. Restraints should not be used for legal reasons because the legal risk from physical restraint use is greater than the legal risk from not using restraints. Sometimes, families request that the patient be restrained. Families should not be decision-makers for restraint use but they may have their say in the care of a loved one. Family involvement and support is critical to secure so that a restraint-free environment can be possible. Control disruptive behaviors, such as agitation, wandering, or combativeness. A major factor driving the use of restraints is the underlying confusion and agitation experienced by patients. Some medical conditions like sepsis may cause patient confusion. Discomfort, surgical and diagnostic procedures, anxiety, and sleep deprivation can result in agitation. If a patient is in ICU, agitation can interfere with mechanical ventilation, cause myocardial stress and cerebral ischemia. Agitation can bring about patient removal of nasogastric tubes, arterial catheters, central venous catheters, urinary catheters, and self-extubation