How Often Do You Check a Patient's Circulation While in Restraints?

Students NCLEX

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I'm getting conflicting answer from different sources. Kaplan says every 30 minutes, but I could swear that somewhere else it's 15 minutes.

Please advise.

Rach10388

98 Posts

circulation is checked every 2 hours, response is checked every 15, and 1:1 sign offs are every 30

Rach10388

98 Posts

at the very least is 2 hours i should say

gatoraims RN

219 Posts

Saunders says every 30 as well.

euphoria02

27 Posts

if a client is in restraints you should release (each restraint) and check circulation q 30 minutes.

NurseGrad10

4 Posts

When I was going over it on nclex 4000 it said to release them every 2 hours and u should check circulation every 10-15 minutes.

for what i understand depends on what kind of restraint you are using, if is for a child or for adult, if is the 4 point bed or seat (used for police and psych units). there are multiple types for multiple body sites, restraint hands in semi-conscious, etc.

now you have to report (document) every 15 min. (observation) and let patient free (physical) every 2 hrs for rom and check circulation (and document). and 1:1 sign offs are every 30, basicly as rach10388 stated.

euphoria02

27 Posts

if a client is in restraints you should release (each restraint) and check circulation q 30 minutes.

my bad... you should release restraints q 2 hours and check circulation q 30 min.

I had a Kaplan qbank question that said to reassess the need for the restraint ever 4 hours. but for skin care and circulation checks, where is this is the course book?

nclexpass

38 Posts

Retrains - check skin integrity and ROM- every 2 hrs, Circulation - every 30 min

Traction - check skin integrity ( hygienic care ) once in a day ( need to provide manual traction) traction free period.

Neurological assessment every -4 hrs

Retrains - check skin integrity and ROM- every 2 hrs, Circulation - every 30 min

Traction - check skin integrity ( hygienic care ) once in a day ( need to provide manual traction) traction free period.

Neurological assessment every -4 hrs

thanks!!

testing2013

1 Post

According to Saunders (p. 181)

Assess skin integrity and neurovascular and circulatory status q 30 min and remove the safety device at least q 2hrs

According to Fundamentals ATI (p. 106)Assessed - Including neurosensory checks of affected extremities (circulation, sensation, mobility). These checks are usually done at least every 2 hr.

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