APPLYING PEDIATRIC RESTRAINTS

Restraints
Any method which restricts a person’s movement, physical activity, or normal access to his or her body\

Mummy restraint
Is used in children to restrict the movement of limbs

Mitten restraint
Is placed on a patient’s hand used to prevent dislodgement of tubes, lines, and catheters

Elbow restraint is used to control the flexion of the patient’s elbow

Purpose
• To carry out physical exam
•To provide safety to child
•To protect the child from injury
•To complete the diagnostic and therapeutic procedures
•To maintain the child in prescribed position
•To reduce the discomfort of child during some test and procedures

Materials and Supplies needed:

•blanket or flat sheet
•gauze bandage
•scissors
•Velcro
•elbow restraint
•mitten restraint
Procedure
1. Assess the need to perform this procedure such as the behavior indicating the possible need for a
restraint to know if the patient needs the restraint
2. Assess he underlying cause for the assessed behavior to have an idea why the patient needs a
restraint
3. Assess what other protective measures might be implemented before applying the restraint to look
for other options instead of directly applying restraint
4. Assess the status of the skin to which the restraint is to be applied to ensure skin integrity
5. Assess the circulatory status distal to the restraint and of the extremities to ensure safety of the
patient
6. Assess the effectiveness of other available safety precautions to avoid having injuries
7. Review the institutional policy for restraints and seek consultation as appropriate before
independently deciding to apply a restraint to follow the institution’s standard of care and to know
the risk management measures
8. Assemble equipment needed for the procedure to ensure that the restraint fits the patient and the
patient’s needs
9. Introduce yourself and verify the client’s identity then explain to the client and family the procedure
to build rapport, to ensure the correct client, and to reduce anxiety and gain cooperation
10. Wash hands and observe appropriate infection control procedure to protect the patient from
pathogens
11. Provide privacy to promote client’s dignity
12. Apply the selected restraint
13. In mummy restraints, position the client in lying position. Make certain the client’s extremities are in
a comfortable position during this procedure to provide better blood flow when performing the
procedure
14. Place the blanket or sheet flat on bed and fold over one corner of the blanket to immobilize the
patient
15. Place the child on the blanket with the neck at the edge of the fold to ensure proper placement of
restraint
16. Pull the right side of the blanket firmly over the child’s right shoulder to ensure the restraint is not
loose
17. Tuck the remainder of the right side of the blanket under the left side of the child’s body to secure
the blanket
18. Repeat the procedure with the left side of the blanket to fully restraint the upper limbs
19. Separate the corners of the bottom portion of the sheet, and fold it upward the child’s neck to cover
and restraint the lower limbs
20. Tuck both sides of the sheet under the child’s body to secure the blanket and prevent it from
getting loose
21. Secure by crossing one side over the other in the back and tucking in the excess to ensure
immobilization
22. In elbow restraints, place the child in lying or sitting position to easily attach the restraint
23. Cover the elbow with a long-sleeved shirt or gauze if irritation or sweating is expected to prevent
damage of skin integrity
24. Place the child’s arm in the center of the elbow to facilitate attachment of restraint
25. Wrap the restraint around the child’s arm and secure with velcro to ensure it is properly attached
26. Observe for coldness and discoloration of fingers to assess if the restraint is not too tight
27. Check for signs of irritation to prevent adding trauma
28. The device should be removed periodically according to institution policy to ensure standards of
care are being followed
29. In mitten restraints, place the child in lying or sitting position for easier access of the hands
30. Apply the commercial thumb less mitt to the hand to be restrained making sure the fingers can be
slightly flexed to ensure comfort of the client
31. Follow the manufacturer’s direction to ensure proper attachment
32. Remove mitt once in a while according to institutional policy to avoid irritation
33. Wash hands and exercise the child’s hand, then reapply the mitt to allow progressive blood flow
34. Document behaviors indicating the need for restraints to apply the appropriate restraints
35. The time the primary care providers were notified of the need of restraints to ensure when the
procedure was carried out
36. The child’s response to the restraint to determine how the patient is tolerating the restraint
37. The times that the restraints were removed and skin care is given to ensure integrity of skin is not
damaged
38. Explanation given to the child and significant others to ensure they understand the reason of the
restraint