Child Restraint During Induction ?

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Wondering how the RN's hold a child still during induction. I've seen a couple of different ways. One way is the "smother" where you kind of throw yourself over the child and try to hold down their arms and legs if they are kicking and screaming. Another way I've seen is to place the child's arms under a blanket and hold the edges of the blanket down close to the child's body so they can't wiggle and grab the mask or pull out their IV. One of our Anesthesiologists is complaining about how we stop the child from wiggling where I work if we use the blanket technique. He is referring to some study that says it causes the child to be frustrated because they can't move their arms ? I thought it was the whole point so that the child can't grab the mask or pull out their IV ? So.. how do the rest of you hold down a wiggling screaming child when you are trying to mask induce ?

No...the REASON they are kicking and screaming is because they are taken away from mommy and daddy and have a ton of people taking them into a strange place, surrounded by tons of activity, and they are trying to hold them down.

That scares a child to death!

If a parent is there, soothing them, holding them until the mask is in place, assuring them the mask isn't going to hurt them and to just breathe....to me, that sounds like alot less traumatic than anything you are describing.

Then once the child is asleep, the parent leaves and waits to be called to recovery, where the parent is again present so the child can see them first thing.

Also, when possible, arrange for a child to be taken into the OR so they can just see the room....alot less scary if they have seen it before.

Someone there needs to get more creative with the process.

No kidding the child is scared to death. We all know that. With certain children, sure you can play games with them, ask them to talk to Big Bird in the mask, play counting games, ask them to smell the strawberries, etc. Nobody likes to have a kid kicking and screaming when they get masked. However the plain and simple fact is... IT HAPPENS. When it does, it's horrible for everyone involved. I certainly don't like to have to hold a child down until they go to sleep. It's one of my least favorite things to do as an OR nurse. I simply wanted to know when it does happen how do other OR nurses go about restraining the kicking and screaming child. I didn't want this thread to turn in to a big debate as to the horrors of children in the OR or how the hospital I work in should change their rules.

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Specializes in OPERATING ROOM, ICU.

As a general rule, the child is help on the lap of the person administering anesthesia. They are talked to and encouraged to "blow up the balloon". Praise is given for their "good job" and "we wonder if they can make the balloon pop". Gas is flowing, of course. Before they realize that they might be getting sleepy, they are relaxing, the OR circulator holds the childs legs and together we lift the little one onto the OR bed. No struggle, no fighting, wiggling, kicking, etc.

Good luck!

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Wondering how the RN's hold a child still during induction. I've seen a couple of different ways. One way is the "smother" where you kind of throw yourself over the child and try to hold down their arms and legs if they are kicking and screaming. Another way I've seen is to place the child's arms under a blanket and hold the edges of the blanket down close to the child's body so they can't wiggle and grab the mask or pull out their IV. One of our Anesthesiologists is complaining about how we stop the child from wiggling where I work if we use the blanket technique. He is referring to some study that says it causes the child to be frustrated because they can't move their arms ? I thought it was the whole point so that the child can't grab the mask or pull out their IV ? So.. how do the rest of you hold down a wiggling screaming child when you are trying to mask induce ?

I've only had to restrain a child once, a big 7 year old autistic boy. PARENTS ARE NOT ALLOWED IN OUR OR, only in preop. So therefore parents can not be there for the masking/ intubation part. Usually we give them a lil sumthin to calm down but couldn't give this kid anything. Parents calmed him down in preop before we took him to the OR. He seemed fine once he got on the OR bed, we were both chatting away but as soon as i put the mask over his face he started to freak out. I calmly talked to him and let him know the mask wouldn't hurt him and that we would take really good care of him and i would be right there holding his hand...etc etc. This kid did not like the mask on his face kept pushing it away from his face, thats when the anesthesiogists told me to hold his hands down. I leaned over and put my upper body over his chest. He had safety straps on his thighs, then i held one of his arms down and the tech held down the other arm. (He was a strong kid). This was necessary because the anesthesiologist could not get anywhere near his face to mask and intubate. I've only seen one other kid do this during my orientation and my preceptor did the same thing. Usually the kids just start crying and don't fight, (the ones i've had). I haven't seen the blanket method yet. I guess we all use the "smother" method for the fighters in our OR.

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Here's the way it ought to go...

Step 1 - sedation - unless there is some reason not to give it, kids get liquid PO versed 20-30 minutes or so prior to the procedure (10 minutes is not long enough for it to work well). Unless it's a really short case, versed is going to be gone pretty quickly and will not delay emergence or turnover times.

Step 2 - Absolutely NO PARENTS in the OR. Having parents in the OR makes mommy and daddy feel better, but does very little for the kids. If anything, the kids pick up on mommy or daddy being scared to death, and they get scared as well. Use Step 1 appropriately.

Step 3 - Depending on what the ANESTHESIA provider wants/needs/is comfortable with, the child can sit on their lap, sit on the table, lie on the table, whatever. Again, STEP 1 makes a big difference here. The size of the child of course makes a difference as well - babies are easier lying on the bed - adult-size kids do as well. My usual position for younger kids is to have them sitting on the OR bed, with their back to my chest. I can hold them gently and hold the mask as well. Someone else can turn up my anesthetic agent.

Step 4 - If they have an IV, there's no reason not to push the drugs and avoid all the hassles. Get them on the table and get them to sleep. Unless the patient is medically compromised, no EKG, no BP until they're asleep - pulse ox is fine if they're holding still - actually, that applies to inhalation inductions as well. Oh yes - Step 1, again, makes a big difference.

Step 5 - During induction, there should be absolutely NO talking in the room whatsoever except for the anesthesia provider doing the induction. The child does not need three people telling them "everything is going to be fine". They don't need to hear banging instrument trays. From the moment I enter the room, I want the kid hearing my calm voice and my calm voice only until they're asleep. I don't stop talking to them until they're asleep - it's almost like trying to hypnotize them - I want them to focus on me, and what I'm saying and doing, without someone or something else distracting them (parents {see step 2} , nurses, surgeon, etc.)

Step 6 - If the child needs to be held or restrained, you'll know. Just do it gently if possible. Someone should already be standing on each side of the bed anyway just in case (you are doing this, right?). And if they start crying and screaming, remember that big cry = big breath in. It only takes 3-4 cries and they're well on their way to la-la land. If Steps 1-5 are followed, most of the time, this is not an issue.

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Step 6 - If the child needs to be held or restrained, you'll know. Just do it gently if possible.

So you didn't answer my original question with all of that. When the child needs to be restrained how does your RN go about it ?

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So you didn't answer my original question with all of that. When the child needs to be restrained how does your RN go about it ?

Easiest way is to have them lean sideways over the child, with their waist essentially surrounded by the side of your body, axilla, and arm. Doing that, you can easily hold their hands/wrists at the same time. Someone else can hold their legs, most often across both thighs. At this point, the child is probably taking big deep breaths between cries - it only takes a few seconds for things to settle down.

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At my facility we do not allow parents into the OR. We do pre op Versed, and start IV's in the older kids. The little ones get their IV's after induction. We seldom have issues with needing to restrain the little ones, but in the case that we do, we use the "smother" technique that you described.

FWIW, My DD, age 4, has surgery on her genitals last year at an affiliated hospital. She cooperated with an IV preop, and I was offered the choice to go back since I was not an "outsider". I chose not to. My DD was comfortable with my explanations of what was going to happen, and I had no urge to see her fasiculate. I can only imagine how disturbing it would be for a parent to see if they didn't know what they were seeing. DD remembers a positive experience from surgery...she got three cool stickers on her chest, did great on the muscle tester (BP cuff) "cus the doctor (CRNA for the record) said that it was the biggest muscles he had ever seen, mommy!", and blew up the green balloon SO BIG!. And then got graham crackers and juice afterwards. I believe based on her experiences that the only thing that I would have contributed would have been letting her feel my anxiety over her procedure.

So to answer your question, we do not use the blanket method, not have I seen it used. I have used and seen the "smother" method, and it works well for us.

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Specializes in OR.
Easiest way is to have them lean sideways over the child, with their waist essentially surrounded by the side of your body, axilla, and arm. Doing that, you can easily hold their hands/wrists at the same time. Someone else can hold their legs, most often across both thighs. At this point, the child is probably taking big deep breaths between cries - it only takes a few seconds for things to settle down.

This is the way I like to do it. Our facility does allow one parent to accompany the child into the OR. It's usually more traumatic for the parent than it is for the child.

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This is the way I like to do it. Our facility does allow one parent to accompany the child into the OR. It's usually more traumatic for the parent than it is for the child.
Which is the exact reason they shouldn't be there.
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Which is the exact reason they shouldn't be there.

But why not?

To me, that is the job of a parent...they need to suck it up and be there for the chlid.

I think it is 100% unnecessary to put a child through any unnecessary trauma IF it can be reasonably avoided.

In emergency situations, obviously it can't be. That is just life.

However, I would hate to think that a chlid's comfort and fears are being completely dismissed just because they are too young to comprehend what is going on, understand what is going on, and too much of a focus on "git'er done".

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But why not?

To me, that is the job of a parent...they need to suck it up and be there for the chlid.

I think it is 100% unnecessary to put a child through any unnecessary trauma IF it can be reasonably avoided.

In emergency situations, obviously it can't be. That is just life.

However, I would hate to think that a chlid's comfort and fears are being completely dismissed just because they are too young to comprehend what is going on, understand what is going on, and too much of a focus on "git'er done".

You need to read my earlier post or read it again if you read it before.

You're thinking that it's better for the child having the parents there. It's not. Parents are understandably stressed about surgery and anesthesia, and kids will pick up on that, even if the parents put on a happy face. It has nothing to do with dismissing the fears of the child, , nothing to do with moving things along, and nothing to do with the parents "sucking it up". I can't tell you how many parents break down, even on minor cases like ear tubes.

It's all about what is best for the child, and having the parents there is rarely, if ever, what's best FOR THE CHILD. I don't care how many parents think their child just won't be able to handle it - that's the parents fear, not the child's.

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This is MY EXPERIENCE AS A PATIENT and what my mom has told me about my past experience that I do not remember :D

I had my first surgery at the age of 2 at one hospital. Aparently I saw a child life specialist a while before. She talked me through what was going to happen and gave me a mask to "practice" with (aka get used to so I did not freak out). My mom says that did wonders because I did wonderful and was excited to show how I knew how to use the mask.

At the hospital I am now a patient they allow 1 parent (or the best person to support the child) into the OR with the child. Also with younger patients the parent is brought into the Post-Op (as it is explained by child life the "wake up room") BEFORE the child is awake.

It is called the PPI (parent present induction program). They screen for appropriatness at the pre-op visit a few days prior to surgery. If a child is found to be a good candidate for the program the staff gets the parent ready to know what to expect. My hospital has been doing it since 1989.

If a child needs to be restrained I do not know how they do it. I have never (to my recollection) needed to be.

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