4 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). Select the least

restrictive but most appropriate restraint for the individual

patient.

A. Definitions

1. Physical restraint: “Any device, garment, material, or

object that restricts a person’s freedom of movement or

access to one’s body” (1)

B. Indications

1. Required for procedures that require 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. 4.1A).

(4) With infant’s right arm flexed and midline, tuck

right side of blanket across trunk and under left

side of body (Fig. 4.1B).

(5) Fold lower corner up toward head and tuck

under left shoulder (Fig. 4.1C).

(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. 4.1D).

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. 4.2A–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).

28 Section I ■ Preparation and Support

Extremity Restraints

1. Extremity restraint (wrist or ankle) (Fig. 4.3)

a. Purpose: Immobilization of one or more extremities;

protects infant from interfering with or removing

treatment regimens (IV access, feeding tube, endotracheal tube, etc.)

b. Equipment

(1) Commercially available restraint (sheepskin

and/or foam padding) for larger infants

OR