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Limb restraint: Wikis


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A limb restraint is a medical restraint that is applied to the arm or leg of a patient to prevent the patient from causing harm to him/herself or others. The most commonly used type of limb restraint is the fabric restraint. The device consists of a cuff that is wrapped around the patient's wrist or ankle, and straps that are tied to the side of the patient's bed or chair[1].

Limb restraints are often used on a combative or disoriented patient who is using his/her arms or legs to strike at staff or others, to pull important medical apparatus, such as an IV tube or catheter, out of one's body[2], or to otherwise interfere with one's care. Arm restraints also become necessary when a patient must lie on his/her back at all times.

Patients who may come in need of limb restraints include those who have suffered a head injury, those recovering from seizures (usually multiple ones), have been under anesthesia for a long period of time, or those suffering from mental illness, dementia, or side effects from their treatment.

Use of limb restraints on both arms and legs at once is known as a four-point restraint. Its use heavily restricts the movement of the patient, and may render the patient helpless when s/he needs to move in an emergency. Many facilities will hire a companion to watch a patient who is placed under four-point restraint.

Most patients who find themselves restrained naturally think they can free themselves by pulling hard at the restraints. But the restraints are made out of plastic mesh, which cannot be broken by being pulled with human strength. Other patients attempt to unfasten the restraints around the wrist, but find they cannot reach the fastener. Some do manage to slip their hands through the cuff, though competent workers prevent this from happening.

The easiest way to free oneself from restraints is to reach with one hand to the side of the bed, which is possible. There, the restraint is tied and can be easily untied. After freeing one arm, it is easy to use it to free the other. The patients who seem to know this the most are those who have previously worked in acute health care settings.


Stronger restraints

For some patients for whom fabric restraints fail to successfully restrain, stronger alternatives are available, though in most places, legal restrictions exist on their use in clinical settings.


Leather restraints

Leather restraints are used for strong patients for whom soft restraints fail to prevent escape. They can be applied around the waist, or to individual limbs.

All restraints require a physician's order to be applied. While fabric restraints can be applied by a nurse temporarily while awaiting for a physician's order in an acute care setting, leather restraints can only be applied if pre-authorized by a physician.

Metal restraints

Metal restraints are usually made of stainless steel. They are used for patients for whom fabric and leather restraints fail to prevent escape. But legally, they can only be used with a court order and with a member of law enforcement present within 500 feet without the use of an elevator or more than one flight of steps up or two down.

Metal restraints are only permitted to be used on patients who are in legal custody or whose behavior in the health care setting is of a criminal nature (e. g. assaulting or making verbal threats of assault toward health care worker). Most jurisdictions have judges on call 24 hours who can issue court orders promptly when necessary.

See also



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