II. Indications
- Dangerous and uncontrolled Violent Behavior
III. General
- Never use for convenience
- Never restrain in prone position (case reports of asphyxia)
- Never place weight on patient's back while prone
- Run like a Resuscitation code
- Command cooperation
- Explain to the patient the need for restraints
- Document justification and frequent Vital Signs
IV. Technique
- Remove jewelry, ties, weapons
- Patient should be positioned supine (not prone)
- May place oxygen mask over the patient's face to prevent spitting
- Apply by at least 5 assistants
- One assistant to secure patient's head
- One assistant per limb
- Tie each leg to the opposite side of the gurney (if not disallowed by facility policy)
- Restraint materials: Five point restraints
- Leather restraints are usually necessary
- Soft restraints may be adequate for elderly
- Figure-of-four arm lock may allow IV placement or IM Chemical Restraint injection
- Patient stays in seclusion room while restrained
V. Management: Monitoring
- Physical Restraints require 1:1 observation (staff is with them 100% of the time)
- Medical provider must order the Physical Restraints and must see the patient within 1 hour of order
- Physical Restraints may not be ordered as needed
- Reevaluation by provider
- Children <9 years: Every 1 hour
- Children 9-18 years: Every 2 hours
- Adults: Every 4 hours
VI. Precautions
- Physical Restraints are a bridge to other management (typically transient use for 30-60 minutes)
- Typically used to obtain IM access to deliver Sedative (e.g. Ketamine, Benzodiazepines, Haloperidol, Olanzapine)
- Prolonged use of Physical Restraints risks life threatening complications for the patient (e.g. Rhabdomyolysis)
- Remove the Physical Restraints once sedation or other effective measures are implemented
- Deaths have occurred in physically restrained children
- Do not partially restrain
- Risk of patient still getting out of bed, falling or Choking
VII. Complications: Patient
- Extremity Injury
- Asphyxiation
- Aspiration
- Lactic Acidosis
- Stress Cardiomyopathy
- Pressure Ulcers
- Venous Thromboembolism
- Rhabdomyolysis
VIII. Complications: Staff
- Eye Injury
- Musculoskeletal Injury (strains and sprains)
- Scratches
- Needlestick Injury
- Blody Fluid Exposure
IX. References
- Mason, Mallon and Colwell in Herbert (2018) EM:Rap 18(10): 11-2
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Related Studies
| Definition (MSH) | Use of a device for the purpose of controlling movement of all or part of the body. Splinting and casting are FRACTURE FIXATION. |
| Definition (PSY) | Use of any physical means to restrict the movement of a client or subject, human or animal. |
| Definition (NIC) | Application, monitoring, and removal of mechanical restraining devices or manual restraints which are used to limit physical mobility of patient |
| Concepts | Therapeutic or Preventive Procedure (T061) |
| MSH | D012149 |
| SnomedCT | 386423001 |
| English | Physical Restraint, Physical Restraints, Restraint, Physical, Restraints, Physical, Physical Restraint (procedure), physical restraint, restraints physical, physical restraints (treatment), physical restraints, Physical restraint (procedure), Physical restraint, Immobilization, Physical, Physical Immobilization, Restraint (Physical) |
| Swedish | Tvång, fysiskt |
| Czech | omezení fyzické |
| Finnish | Liikkuvuuden rajoittaminen |
| Russian | FIZICHESKIKH DVIZHENII OGRANICHENIE, ФИЗИЧЕСКИХ ДВИЖЕНИЙ ОГРАНИЧЕНИЕ |
| French | Immobilisation physique, Contention physique, Contrainte physique |
| Italian | Contenzione fisica, Immobilizzazione fisica |
| Polish | Przytrzymanie, Unieruchomienie fizyczne, Przymus fizyczny, Przymus bezpośredni |
| Japanese | 身体抑制, 拘束-肉体的, 束縛-肉体的, 肉体的束縛, 抑制-身体, 抑制法-肉体的, 肉体的抑制法, 肉体的拘束, 身体拘束 |
| Croatian | FIZIČKO SPUTAVANJE |
| Norwegian | Fysisk restraint, Fysisk tvang, Tvangstrøye, Fysiske tvangsmidler |
| Spanish | restricción física (procedimiento), restricción física, Restricción Física |
| German | Fixierung (Psychiatrie), Körperliche Zwangsmaßnahme, Zwangsmaßnahme, körperliche |
| Dutch | Beperking, fysische, Fysische beperking |
| Portuguese | Restrição Física |
Ontology: Patient restraint (C1095960)
| Concepts | Therapeutic or Preventive Procedure (T061) |
| Italian | Contenimento del paziente |
| Japanese | 患者拘束, ｶﾝｼﾞｬｺｳｿｸ |
| Czech | Nucený pobyt pacienta |
| English | patients restraints, patient restraints, restraint patient, patient restraint, Patient restraint, Restraint of patients |
| Hungarian | Beteg korlátozása |
| French | Patient soumis à une contention |
| Portuguese | Restrição dos movimentos do doente |
| Spanish | Restricciones al paciente |
| Dutch | dwangmiddel voor de patiënt |
| German | Einen Patienten unter Gewahrsam stellen |
