Discussion

wrist restraints

Jul 7, 200619 yr

I want opinions of RNs based on wrist restraints being used on patients please!

I know someone who is hopitalized and had been on a ventilator. Wrist restraints were being used on this patient to prevent them from pulling out lines or restricting their ability to get out of bed in combination with a belt restraint. The patient is unable to pass an orientation assessment test. But, they had a history of trying to get out of bed. If the patient was left alone without the wrist restraints, but with the belt restraint and that patient climbed out of bed and the belt restricted their ability to breath and that patient respiratory arrested,and CPR was performed to resusitate the patient.

If the patient had been wearing the wrist restraints, Could that have been another preventable measure to assure that this patient could not get out of bed?

Any opinions would be greatly appreciated!!

Jul 7, 200619 yr

Experts

Having never seen or used wrist restraints before coming to this country, I am of the opinion that neither the belt nor the wrist restraints work as well as we would hope. I have seen pt escape from both if the will is strong enough. In the UK we used sedatives as a form of restraint, again there are problems with using this kind of restraints. There doesnt seem to be anything that is perfect.

I know I am not much help. Sorry

Jul 7, 200619 yr

I want opinions of RNs based on wrist restraints being used on patients please!
I know someone who is hopitalized and had been on a ventilator. Wrist restraints were being used on this patient to prevent them from pulling out lines or restricting their ability to get out of bed in combination with a belt restraint. The patient is unable to pass an orientation assessment test. But, they had a history of trying to get out of bed. If the patient was left alone without the wrist restraints, but with the belt restraint and that patient climbed out of bed and the belt restricted their ability to breath and that patient respiratory arrested,and CPR was performed to resusitate the patient.
If the patient had been wearing the wrist restraints, Could that have been another preventable measure to assure that this patient could not get out of bed?
Any opinions would be greatly appreciated!!

I'm sorry, this sounds like you are using our advice to set up a lawsuit of some sort. We are not here to offer medical advice or do legal consulting.

If this is a case, you need to contact a lawyer. They have doctors and nurses on hand to deal with just this sort of thing.

Jul 7, 200619 yr

I want opinions of RNs based on wrist restraints being used on patients please!
I know someone who is hopitalized and had been on a ventilator. Wrist restraints were being used on this patient to prevent them from pulling out lines or restricting their ability to get out of bed in combination with a belt restraint. The patient is unable to pass an orientation assessment test. But, they had a history of trying to get out of bed. If the patient was left alone without the wrist restraints, but with the belt restraint and that patient climbed out of bed and the belt restricted their ability to breath and that patient respiratory arrested,and CPR was performed to resusitate the patient.
If the patient had been wearing the wrist restraints, Could that have been another preventable measure to assure that this patient could not get out of bed?
Any opinions would be greatly appreciated!!

Well that is a good question, The idea is generally the least restrictive possible so it the patient only risk is getting out of bed, then wrist restraints weren't indicated. IF they had on wrist restraints, he may have still been able to get oob and then be hanging by his wrists. It sounds if the belt wasn't on properly (sp) but that is just a guess. It is hard to second guess what could have or should have happened. But that is one of the reasons why restraints are not popular to be used for that exact reason.

Jul 7, 200619 yr

I'm sorry, this sounds like you are using our advice to set up a lawsuit of some sort. We are not here to offer medical advice or do legal consulting.
If this is a case, you need to contact a lawyer. They have doctors and nurses on hand to deal with just this sort of thing.

OH OH I didn't take it like that at all:uhoh3:

Jul 7, 200619 yr

Experts

http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=3515&nbr=2741

Here are some guidelines for the best practices for use of restraints (ideally, not at all.)

Short version:

Should be least restrictive possible.

Shouldn't be used for staff convenience (this includes short staffing - i.e. can't tie 'em up because you have no one to keep an eye on them.)

Jul 8, 200619 yr

Author

I'm sorry, this sounds like you are using our advice to set up a lawsuit of some sort. We are not here to offer medical advice or do legal consulting.
If this is a case, you need to contact a lawyer. They have doctors and nurses on hand to deal with just this sort of thing.

I'm asking only for opinions! Not medical advice or legal consulting. I know who to contact. Are opinions allowed?

Jul 8, 200619 yr

Experts

sorry if some of our long term members interpreted your post as collecting info for lawsuit...seen too many posters over the years use our board to do that which is against our terms of service:

terms of service - all users please read and follow

it was my first impression too.

when i started in healthcare in mid 1970's, restraints were a frequently ordered item to prevent self harm. best practice standards have shown (and my own observations over the years concur) that restraints should be used as a last resort ---per article above.

having cared for vent dependent patients since 1979, my experience has been that wrist restaints themselves are insufficient from keeping a person in bed---that is not their intended purpose either. purpose of wrist restraintsfor intubated patient is to prevent self extubation (pt has tried in the past) or from removing iv devices

the posey company is manufacturer of restraints that i am most familiar --website: https://secure.posey.com/poseystore/default.aspx

check out their instruction sheet:

application instruction sheet posey® limb holders

https://secure.posey.com/poseystore/files/2530.pdf

look at right site pictures under #7

#7 after applying a restraint or self release product; always put all side rails in the up position.

side rail covers, or gap protectors, especially with split side rails, may be required to keep the patient on top of the mattress, and avoid entrapment zones.

if the patient's body weight becomes suspended off the mattress by going under, around, over, through or between the side rails, chest compression and suffocation could result.

restraints with pelvic pieces may be necessary to reduce sliding down or pulling the restraint over their head.

pictures show how with just wrist restraints on, patient can slide out of bed and cause harm...seen intubated vented patients try to slide out of bed on rare occasion even with me next to their bed. at that point we'd reassess our game er care plan on how to best manage this patient to protect him from harm, keeping airway secure, until we can extubate successfully.

prior to the nicotine patches, many patients wrote on magic boards they were trying to get up to grab a smoke!

many variables go into why intubated patients are attempting to extubate themselves and need to be restrained.

posey website has many educational articles that might be of interest to nurses regarding restraint use.