restraint

RESTRAINT PROCEDURE

1. NURSING PROCEDURE ON RESTRAINT

2. DEFINITION: Restraints are protective and mechanical devices which are used to minimize the movements and protects the child from injury. These restraints are made up of linen, canvas, plastic, metal or wood.

3. PURPOSES: To carry out the physical examination To provide safety to the child To complete the diagnostic and therapeutic procedure To protect the child from injury To maintain the child in prescribed position To reduce the discomfort of child during some test and procedures like specimen collection.

4. ARTICLES NEEDED Baby blanket or draw sheet -‘4 ‘bandage for clove hitch knot -Cotton pads -Restraint cloth with pocket -Wooden or plastic strip to keep in pocket for elbow restraint. -Scissors to cut the bandage -Jacket for jacket restraint -Adhesive tape to fix the bandage

5. GENERAL PRINCIPLES: Always select the safe and appropriate restraint. Restraint should not be too tight. It should not interfere with the normal circulation. -Use appropriate cotton pad for maintaining the comfort of child -Explain the restraint and it is important 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 raised to prevent traction -Observe restraint every 20-30minute to prevent any complication -Do not give too much tight knot. It should be easily releasable -Do not do purposeless restraining -Do the recording and reporting

6. TYPES OF RESTRAINING: -Mummy restraint -Elbow and knee restraint -Jacket restraint -Extremity restraint (clove hitch knot) -Crib net restraint -Side rail -Safety belt -Finger restraint -Abdominal restraint

7. MUMMY RESTRAINT

8. PURPOSE Mummy restraint is used for the children to restrict the movement of limbs. It is used for examination procedure and treatment of head, neck and face.

9. PROCEDURE FOR MUMMY RESTRAINT Take a blanket or draw sheet and spread it over the bed or table. Place the baby on back side keep one hand of baby near the body and wrap the baby’s body by holding the corner of sheet and tuck it under the body in opposite side. Place another hand near the body and wrap the child body by holding another corner of sheet and tuck it. Take the rounded sheet at bottom near the leg and fold towards the chest and tuck at upper level of sheet it restrict all the extremities.

10. ELBOW AND KNEE RESTRAINT

11. PURPOSE Elbow and knee restraint is used to control the flexion of elbow and knee. PROCEDURE keep the wooden or plastic strip in pocket of cloth. These pockets are vertical. Place the cotton on elbow and knee and adjust it with central location and tie the both side strips properly. The elbow restraints are used in case of face and head surgeries. Eg;Cleft lip and cleft palate, scalp vein etc.

12. CLOVE HITCH KNOT RESTRAINT

13. PURPOSE To immobilize leg or arm PROCEDURE C repe bandage and 2inch 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 in the wrist or on the ankle. Tie the bandage by knot. Knot should not be too tight or too loose. Child can remove the knot if it is too loose. Too tight can interfere in blood circulation. The finger and toes should be checked for discoloration or any skin rash etc.

14. JACKET RESTRAINT

15. PURPOSE To prevent the child from fall and injury PROCEDURE In this method a jacket made up of soft cloth and leather . This jacket has lace at the back and two long strips. The lace is tied at back and long strip tied at the side below the rail under the mattress. Child can sit and sleep in supine position while wearing jacket it can also use on chair. This restraint is used to avoid the child from climbing over side rail, climbing out from chair, bed, cot etc. It prevents the child from fall and injury.

16. CRIB NET RESTRAINT

17. CRIB NET RESTRAINT In this a net is used to cover the Childs cot net is attached to the cot frame. This net restraint is used to prevent the children climbing over the side rails of cot. In this net, when side rails are up the child can stand but cannot climb 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 of cot.

18. SIDE RAILS

19. SIDE RAILS These are available especially in children cot. The rails are made up of iron or steel. These can be raised whenever need arises and can be decreased, as per convenience the main purpose of side rails are to prevent from fall.

20. SAFETY BELTS

21. SAFETY BELTS These are made up of electrically non conductive materials. These belts are used on stretcher and operation tables to prevent the children from falling. These belt go around the Childs waist and tied to the frame of bed under the mattress.

22. FINGER RESTRAINT

23. FINGER RESTRAINT It can be completed by making a mitten. the mitten cover all fingers of a hand and restrict the movement of finger. The hand can be wrapped by the 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 part. keep the mitten soft and it should not interfere with circulation.

24. ABDOMINAL RESTRAINT

25. ABDOMINAL RESTRAINT This restraint is used to hold the infant in a supine position on the bed. Abdominal restraint should not be too tight, 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.

26. COMPLICATIONS It can interferes the child’s muscular development due to lack of movement. If restraint is too tight, it causes obstruction in blood circulation, tissue damage, redness, scar formation etc. Dislocation of the shoulder joint may occur if the child struggles during application of arm restraint Hypostatic pneumonia due to immobility ischemia or nerve damage due to constrictive restraint Psychic injury to the child, the child feels that he /she punished alternation in self body image. Disturbance in psycho social development.

27. NURSES RESPONSIBILITY Explain the reason for the restraint to the parent and child. Free movement facilitates growth and development. Adequate padding under wrist and ankle restraint essential to prevent skin irritation. Good body alignment should be maintained. Any kind of restraint must be checked every 15 minute and removed periodically. Regular monitoring and decision making trial inclusive of ongoing review of the need for restrain. Meet the safety, comfort, psychological need inclusive of nutrition and hydration. It is the responsibility of the nurse to assess the child behavior and environment to promote the safety of child

28. CONCLUSION Restraints are protective and mechanical devices which are used to minimize the movement and protect the child from injury. The purpose of restraint is to provide safety to child and maintain child in a prescribed position. There are various type of restraint used in paediatric