physical restrain in icu

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