Restraints in neonates refer to the temporary restriction of movement to ensure safety, medical procedures, or therapeutic interventions. They are used to prevent injury, facilitate examinations, or support treatment while minimizing distress.
Key Aspects of Neonatal Restraints
Ethical Use: Should be minimized and used only when necessary for medical reasons.
Purpose: Used for diagnostic procedures, IV therapy, or preventing self-harm.
Safety Considerations: Must be gentle, properly fitted, and monitored to prevent discomfort or circulation issues.
Types of Neonatal Restraints
| Type | Purpose | Nursing Considerations |
|---|---|---|
| Mummy Restraint | Used for short-term immobilization during procedures like IV insertion or head examinations. | Ensure proper wrapping to avoid restricting breathing or circulation. |
| Elbow Restraint | Prevents flexion of the elbow to stop neonates from pulling out IV lines or touching surgical sites. | Monitor for skin irritation and ensure comfort. |
| Extremity Restraint | Restricts movement of arms or legs for procedures like blood draws or catheter placement. | Check circulation and skin integrity frequently. |
| Jacket (Vest) Restraint | Used to keep neonates in a secure position, often in NICU settings. | Ensure proper fit to prevent discomfort or breathing restriction. |
| Crib Net Restraint | Limits movement within the crib to prevent falls or accidental removal of medical devices. | Use only when necessary and monitor for distress. |
Indications
- When child’s behavior is out of control and puts himself or others in danger, for example, drug use, head injury, or mental disorder.
- While doing the procedures, for example, venipuncture.
- After surgery, for example, wrist restraints to prevent the child from pulling out tubes or other medical devices.
Principles
- Identify risk factors such as prematurity, maternal complications, or fetal distress.
- Prevent hypothermia by drying the neonate and using warm blankets or radiant warmers.
- Maintain a neutral thermal environment to support physiological stability.
- Position the neonate with a neutral head alignment to ensure an open airway.
- Suction secretions only if necessary, avoiding deep suctioning to prevent bradycardia.
- Tactile stimulation (rubbing the back or flicking the soles) to encourage spontaneous breathing.
- If ineffective, initiate positive pressure ventilation (PPV) using a bag-mask device.
- Monitor chest rise to confirm effective ventilation.
- If heart rate is <60 bpm, begin chest compressions at a ratio of 3:1 (compressions to breaths).
- Administer oxygen therapy based on neonatal needs.
- Epinephrine may be required if heart rate remains low despite ventilation and compressions.
- Dextrose for hypoglycemia and volume expanders for shock management.
- Monitor for respiratory distress, hypoglycemia, and temperature instability.
- Provide parental support and education on neonatal health.
Guidelines for Use of Restraints
- At least two caregivers are needed to physically restrain the child.
- Physical restraint should be used in a quiet environment away from other babies.
- Mechanical restraints to be used must be easy to remove in the case of an emergency.
Hazards of Restraints
- If restraint is too tight, it can cause obstruction in blood circulation, tissue damage, redness, scar formation, discoloration of the skin, etc.
- Nerve damage.
- Psychological disturbance.
- Alteration in body image.
- Disturbance in normal development.
- Accidental or intentional removal of restraints may result in possible removal of tubes, IV lines, injury, etc.
- Injury to restrained extremity.
- Fracture or muscle strains during application with violent patient.
- Dislocation or contusion of extremity.
- Numbness and tingling in restrained extremity.
Nurse’s Responsibilities
- Assess risk factors such as skin integrity, circulation, and distress levels.
- Use gentle and correctly fitted restraints to prevent injury.
- Ensure minimal restriction while maintaining safety.
- Check for signs of discomfort, impaired circulation, or skin irritation.
- Reassess the need for restraint at regular intervals.
- Record the type, duration, and reason for restraint use.
- Inform parents and caregivers about the necessity and safety measures.
- Use restraints only when necessary and for the shortest duration.
- Prioritize alternative methods such as swaddling or distraction techniques.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
- Naveen Bajaj, Rajesh Kumar, Manual of Newborn Nursing, 2nd Edition, 2023, Jaypee Publishers, ISBN:978-9354659294
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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