Principles Of Application Of Restraining Devices

The following principles of application are important and must be observed when applying restraining devices.

a. Do not attempt to apply restraining devices alone. There should be an adequate number of personnel available to safely and efficiently restrain a patient.

b. The patient's ankles and wrists must be padded prior to applying restraints. Padding helps prevent chaffing and/or cutting of the skin.

c. Restraints should fit snugly to prevent escape, but should not restrict circulation or impair breathing. You should insert two fingers under the restraining straps to check for tightness. If your fingers can be comfortably inserted under the straps, the restraining straps are thought to be snug and should not restrict circulation.

d. Restraints must be placed so that no further injury will be done to a wound or interfere with therapeutic treatment such as IV infusions, tubes, or catheters. However, the restraints must prevent the patient from removing therapeutic devices.

e. When ankle restraints are applied, wrist restraints must also be applied. The wrist restraints will prevent the patient from using his hands to place himself in a position to hang from his ankles or to release the ankle restraints.

f. The patient should never be restrained on a portable commode or rocking chair. Both can be tipped over.

g. Straps should not be attached to the bed's side rails. If the side rails are lowered, the patient could be injured.

h. A depressed patient, or one having an altered level of consciousness, should not be restrained on his back with his limbs at his side. These patients should be placed in a prone position (face down) prior to applying restraints. Placing a patient in a prone position prevents aspiration if he should vomit.

NOTE: Aspiration and suffocation are potential dangers because the patient may have difficulty handling his secretions or emesis.

i. The patient should be checked frequently for signs of distress and security of restraints at least once every half hour or as directed by a physician. This check will also reassure the patient of your concern for him and that he is not being punished.

j. The restraints should be released one at a time and the patient's position should be changed at least once every two hours, day and night. Each of the patients limb should be exerci sed through its normal range of motion.

NOTE: Release avoids excessive stiffening of muscles.

k. Keys to unlock the restraints must be readily available whenever a patient is placed in a locked restraint; all personnel must carry a key.

l. Restrained patients should be in a comfortable position. The head of the bed or litter may be elevated so that the patient can see his environment. This will assist in the patient's reorientation and decrease his confusion. The patient must know that you are concerned about his physical and emotional well-being and that the restraints are used for his protection.

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