Many restraints are available to provide safety for the patient. Each restraint has a specific purpose; using the least restrictive device that maintains adequate protection is a legal and professional standard for the nurse. The manufacturer’s directions for use must be followed. All restraints are considered medical devices and therefore must receive FDA approval. Facility-produced devices do not have FDA approval and therefore do not meet this standard.
Belt restraints are threaded at the back and are used to prevent the patient from falling out of the bed or chair. The belt is fastened around the patient’s waist, and the ties are fastened to the bed or wheelchair frame. Disposable belt restraints also are available.
These canvas or mesh vests have long ties that are secured to the bed frame. The ties may cross at the front back, depending on the design of the vest. Vest restraints are used when the patient needs more support or a stronger reminder than a simple belt provides. Attach the ties to the non-movable part of the bed. Some vest restraints have shoulder loops. If the patient is unable to maintain an erect posture, short straps can be passed through the loops and slipped over the wheelchair handles to prevent leaning forward.
Jacket restraints fit over the patient’s head. The neck opening is secured with a zipper or Velcro closure. There are secure ties fixed to the waist of the jacket. These ties may then be tied to the bed or wheelchair frame.
Elbow or Knee Restraints
These are canvas or mesh wraparound ties that have lengthwise rigid stays to prevent joint flexion. They are used most often to prevent the pediatric or confused patient from disturbing a tube or dressing or from scratching a rash.
Wrist or Ankle Restraints
Commercial wrist or ankle restraints are cloth straps with a thread-through buckle device or Velcro cuff. They are usually used to restrict motion of a limb for therapeutic reasons, such as to maintain an IV or prevent the patient from pulling out a tube. Slip the device on the patient’s wrist or ankle, thread it, and tie it to the bed frame; never tie it to a side rail because if the rails were suddenly lowered, the patient could be injured. Attach wrist and ankle ties to the movable portion of the bed frame so that if the head or foot of the bed is raised, the ties will not be pulled. Disposable wrist and ankle restraints, made of fabric or soft but strong paper, also are available.
Mitt restraints are used for patients who absentmindedly pull at tubes or appliances or who may injure themselves by scratching a rash or picking at a wound. They restrict only the hand and fingers and allow the arm to move freely. Mitts are available commercially, or they can be made by wrapping the hands loosely with strips of soft fabric or rolls of dressing material. Secure the wrapping with paper tape to prevent skin irritation and allow easy removal. Remove the mitts periodically, as you would other devices, to clean and exercise the hands and fingers.