30 Section I ■ Preparation and Support

Fig. 4.4. Elbow restraint.

(1) Commercially available restraints (sheepskin

and/or foam padding) for larger infants

OR

(1) Foam-padded armboard

(2) Adhesive tape

(3) Additional padding material (i.e., cotton balls,

gauze pads)

c. Procedure:

(1) Cut four pieces of tape (appropriate size; tape

should not completely encircle extremity).

(2) Extend upper extremity.

(3) Place armboard under elbow to eliminate the

ability to flex joint.

(4) Tape extremity securely to armboard. Tape

should be applied above and below elbow joint.

(5) Pad bony prominences with cotton as needed.

Restraints for Vascular Access

Restraints can be used to secure IV access and prevent accidental dislodgement.

1. Equipment

a. Restraint device (i.e., armboard). Armboards vary in

size; a larger infant may require an armboard that is

1 to 2 cm wider than the hand/foot and extends from

the proximal joint to the distal joint. However, to

maintain functional position and natural curvature

of the hand at rest for long-term restraint, the armboard can be shorter in length to allow for curvature

of fingers around the end of the board.

b. Adhesive tape: Transparent tape is recommended for

visualization of IV site especially during continuous

infusion.

c. Additional padding material (i.e., cotton balls, gauze

pads)

2. Procedure

a. Ensure that the infant’s extremity is in a developmentally appropriate position.

b. Assess skin integrity where restraint is to be applied.

c. Apply restraint board using transparent tape. Do not

allow tape to encircle extremity. Three pieces of

tape should sufficiently restrain the extremity and

allow for visualization of the tips of fingers (Fig. 4.5)

or toes (Fig. 4.6 A&B). The sequence of tape allows

for functional positioning of thumb and ankle.

d. Pad bony prominences and maintain natural curvature of extremities (especially the hand and fingers).

Fig. 4.5. Restraint for vascular access—wrist and forearm. Tape

is applied in order, 1 through 3, as shown.

Chapter 4 ■ Methods of Restraint 31

Fig. 4.8. Side-lying positioning is the best alternative to prone for

procedures and sleeping. This position allows for more midline

positioning of the upper and lower extremities. Nesting support

increases postural stability and decreases arching of the back.

Fig. 4.7. Prone positioning during procedures and at rest provides for improved breathing and sleep, lower expenditure of

energy, and more stable physiologic functioning. Care must be

taken to create positioning support of the trunk and hips.

E. Precautions

1. Restraints should be a last resort after other reasonable

alternatives have failed, including close observation, treatment and/or medication change, modification of environment, etc. Document use of alternative methods (1).

2. For restraints during procedures, proper techniques for

analgesia, sedation, and distraction (pacifier, touch, sound,

etc.) may be necessary in addition to the restraint (2).

3. Developmentally supportive restraints may still be preferable to excessive use of sedative drugs (3).

4. Family education regarding the need, procedure, and

time frame for the use of the restraint is required.

Provide an opportunity for collaboration with the family. If possible, remove the restraints when the family is

visiting (1).

5. Weigh equipment required for restraints (i.e., armboards) prior to use. If possible, maintain a list of the

B

A