Methods of Restraint
Margaret Mary Kuczkowski
Physical restraints are required for proper positioning for certain procedures. Infants may also need to be restrained to prevent accidental injury or interference with treatment (i.e., removal of feeding tubes, catheters). Always select the least restrictive but most appropriate restraint for the individual patient.
A. Definitions
B. Indications
1. Required for procedures that necessitate proper positioning to maintain asepsis and facilitate access to patient (IV placement, lumbar punctures, etc.) (1)
2. To reduce the risk of interference with treatment (removal of feeding tubes, IV access, mechanical ventilation, etc.) (2)
3. To prevent movement artifact for radiographic studies and MRI (3)
4. To prevent accidental injury
C. Contraindications
Restraints Should Not Be Utilized
1. When close observation of the patient could protect against potential injury or potential interference with treatment (1, 2)
2. When a change in treatment or medication regimen could protect against potential injury or interference with treatment (1, 2)
3. When modification of the patient’s environment (decreased stimuli, appropriate developmental positioning, reduced noise) could protect against potential injury or interference with treatment (1, 2)
4. When use of a restraint could compromise patient care, procedures, or emergency access (1)
D. Techniques
Restraints for Procedures/Positioning
Whole Body Restraints
1. Mummy Restraint
a. Purpose: Safe temporary method for restraining infants for treatment or examination; allows unimpeded access to head and scalp; individual extremities can be released for access for examination or treatment (1, 2)
b. Equipment
(1) Clean blanket or small sheet
(2) Safety pins or other device for securing final blanket fold
c. Procedure (1)
(1) Open blanket or sheet.
(2) Fold one corner toward the center.
(3) Place infant on blanket, with shoulders at fold and feet toward opposite corner (Fig. 5.1A).
(4) With infant’s right arm flexed and midline, tuck right side of blanket across trunk and under left side of body (Fig. 5.1B).
(5) Fold lower corner up toward head and tuck under left shoulder (Fig. 5.1C).
(6) With infant’s left arm flexed and midline, tuck left side of blanket across trunk and under right side of body. Be sure to secure arms under blanket (Fig. 5.1D).
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2. Commercial restraints for special procedures
a. A “papoose board” is a flat padded board with canvas straps and Velcro closures and is often used for circumcisions in neonates.
b. Specially designed sterile wraps to restrain newborn infants for umbilical venous catheterization or for lumbar punctures (Fig. 5.2A-C).
c. Vacuum immobilization bags (MedVac Infant Immobilizer Bag, CFI Medical Solutions, Fenton, Michigan) are useful for performing MRI and CT scans in newborn infants and usually eliminate the need for sedation (3).
Extremity Restraints
1. Extremity restraint (wrist or ankle) (Fig. 5.3)
a. Purpose: Immobilization of one or more extremities; protects infant from interfering with or removing treatment regimens (IV access, feeding tube, endotracheal tube, etc.)
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