Non-behavioral Wrist Restraints and Restraint Mittens (Nursing)

by Samantha Rhea, MSN, RN

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      Slides Applying Restraints Nursing.pdf
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      Review Sheet Non-behavioral Restraint Usage Nursing.pdf
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    00:04 Let's take a look here at applying non-behavioral wrist restraints.

    00:08 Now, wrist restraints are probably going to be some of the most common restraints that you're going to use.

    00:14 So first of all you're going to use and get your facilities wrist restraints that they have on hand.

    00:20 First, you're going to perform your hand hygiene and position your patient.

    00:24 Now make sure you place the limb in the soft padded portion of the restraint.

    00:29 That's the nice thing about most wrist restraints, they have a little excess padding around the skin.

    00:34 So it doesn't make it so hard or scratch or tear up the patient's skin here.

    00:38 Now, we need to fasten the restraint, there's a little buckle on top of that, that will connect and then adjust the straps to the correct tightness.

    00:46 Now, notice here on the top of this image there's a tail with the wrist restraint.

    00:51 You're going to tighten this for whatever size your patient's wrists are.

    00:56 Now, it's really important that it's not too tight, so we perform a two finger circulation check.

    01:02 So, all we mean by this, is we take two fingers, slide it under the restraint and if there's that much room, we're good to go.

    01:10 Now, we want to fasten the restraint to the bed and remember, a non-moving part, using a quick-release knot.

    01:17 Now we can perform our hand hygiene and document our procedure.

    01:26 Let's take a look at non-behavioral wrist restraints.

    01:29 So when we're applying it, let me show you a piece of equipment.

    01:33 So this is what we call our soft wrist restraints.

    01:38 So it comes a couple of different ways, so I showed you earlier how to do a quick-release knot, but some wrist restraints come with this end to it.

    01:47 So notice how this buckles, so if I unbuckle this, this is the piece that's going to go to the bed.

    01:52 So let me show you that piece.

    01:55 So this is really nice, because this offers a quick unbuckle, instead of a quick-release knot like I had showed you earlier.

    02:03 So this is the piece that's going to go to the bed frame, so really you'll just notice here's the end of the buckle and here's a piece and an opening as well.

    02:11 So, I'm going to feed this through the bed frame and remember a non-moving part of the bed is essential.

    02:18 Now I'm going to take my buckle and put it through the small loop on the restraint itself and just feed this through.

    02:25 So again, this is here and we can remove this quickly if needed with a buckle, so now I'm going to apply my buckle, now I've got this piece attached to the bed.

    02:36 So let's take a look closer look at the wrist restraint itself.

    02:40 So, this also has a buckle, to open this up on the patient.

    02:48 So as you notice, this is a really nice soft material, this is really helpful, because when it's around the patient's wrist, it's not going to really excoriate or tear up the patient's skin.

    02:59 So now, also if you notice, there's a little velcro piece we're going to open this up and this is what we apply around the patient's wrist, so I'll do that now.

    03:13 So I'm going to apply the wrist restraint around the patient's wrist.

    03:18 We've got this little velcro piece that goes on top, then I'm going to take that other buckle and secure it.

    03:27 Now, this is the piece that may need adjusted, so you may have to adjust this for the size of your patient's wrist.

    03:36 So here's my buckle, I've latched that on and I've tightened this with this tail.

    03:44 Now, what's essential here, if you remember, always perform your two fingers finger circulation check.

    03:50 So, I'm going to take my two fingers and slide it under the wrist restraint.

    03:55 See how I can get my two fingers underneath here, that's really essential, however if you notice, I can almost put three fingers, so this is a little bit loose and I need to re-adjust.

    04:19 I'm going to re-velcro and re-buckle.

    04:24 So now, I'm going to take my two-finger circulation check and I can just barely wiggle my two fingers underneath there and that's the amount of tightness we want around the patient's wrist.

    04:35 Now sometimes the patient, as you notice they're secured, but there's so much slack, they can still interfere and pull with medical treatment, pull out their nasogastric tube for example or their IV.

    04:47 So sometimes, we may need to pull up some slack.

    04:50 So if you notice on your wrist restraint, remember this is a piece to the bed and this is the piece to the patient.

    04:58 So to adjust the length, we may need to take this piece, by the buckle and pull this to make it a little tighter for the patient and to pull up some extra slack.

    05:09 So now, we don't have quite so much freedom, again, that's still quite a bit, so we may need to adjust it some more and we're going to pull this to where we feel is appropriate for our patient.

    05:29 So, let's look at the skill "Applying restraint mittens".

    05:32 Okay you may be thinking what are the mittens? Well, let me show you.

    05:37 Okay so this is a restraint mitten, so it may look a little odd, but this is really helpful to keep the patient from pulling out maybe their feeding tube for example or pulling on an IV line.

    05:48 This actually just really places on the patient's hands, so it keeps their grasp from grabbing a line.

    05:55 Now, one thing to know in regards to mittens.

    05:58 Now if I place this on my hand, I can still freely move around right, so these are great restraint alternatives.

    06:05 However, any time that you put this on a patient and then you have to affix it to the bed, remember anytime the patient is affixed to the bed with the restraint, that's going to be the restraint, but the mitten itself is not a restraint.

    06:20 So just keep that in mind, these are great alternatives, but for this demonstration, we're going to show you how to place on the mitten.

    06:28 So now let's take a look at what we're going to need, well of course the restraint mittens themselves.

    06:32 I just showed you one example, now know that there are some variations to this, so make sure you check with your agency's equipment and what you have at your facility.

    06:42 So before we get started, make sure you perform your hand hygiene and position your patient comfortably.

    06:47 Now, when we put the patient's hand in the mitten, they're going to put their hand palm down.

    06:54 Then we're going to separate the fingers if the mitten has separators.

    06:58 Some of these, like I said, there's a variation to those and there's little finger slots that you can slide the patient's hand in.

    07:05 Then, we're going to wrap the strap around the wrist to secure it and then we're going to secure it with a fastener on the mitten itself.

    07:13 Now, here's where we need to adjust the straps to the correct tightness and don't forget to make sure it's not too tight.

    07:20 This is where we perform a two finger circulation check.

    07:24 What I mean by this again, is taking your two fingers sliding it underneath the mitten that we just secured and make sure there's enough room to slide into fingers and again we do this to make sure it does not impede circulation on our patient.

    07:39 Now, we can fasten that restraint to the bed using a quick-release knot.

    07:43 And then once we've done this, we'll perform our hand hygiene and document the procedure.

    About the Lecture

    The lecture Non-behavioral Wrist Restraints and Restraint Mittens (Nursing) by Samantha Rhea, MSN, RN is from the course Restraint Management and Application (Nursing).

    Included Quiz Questions

    1. The nurse makes sure they can slide two fingers under the restraint.
    2. The nurse makes sure they cannot slide two fingers under the restraint.
    3. The nurse makes sure they can slide their hand under the restraint.
    4. The nurse makes sure they can slide four fingers under the restraint.
    1. The student nurse applies the restraint so the soft padded portion of the restraint is on the outside.
    2. The student nurse makes sure the client is in a comfortable position before applying the restraint.
    3. The student nurse tightens the restraint until they can slide two fingers under the restraint.
    4. The student ties the restraint to the bed frame using a quick-release knot.
    1. The student nurse places the client’s hand into the mitten palm up.
    2. The student nurse makes sure they can slide two fingers into the mitten.
    3. The student nurse wraps the strap around the wrist and secures it with the fastener.
    4. The student nurse secures the strap of the restraint mitten to the client's bed rail.
    1. “A restraint mitten by itself is not considered a restraint.”
    2. “A restraint mitten that is secured to the bed is a restraint.”
    3. “A restraint mitten by itself is considered a restraint.”
    4. “A restraint mitten cannot be secured to the bed.”

    Author of lecture Non-behavioral Wrist Restraints and Restraint Mittens (Nursing)

     Samantha Rhea, MSN, RN

    Samantha Rhea, MSN, RN

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