Pediatric emergency medicine trisk 4316 4316

Indications
Restraint should be considered in the performance of those procedures in which
excess movement will be detrimental to the safe and successful completion of the
procedure. Excess movement can lead to patient or medical provider injury,
prolonged procedural time, and suboptimal procedural outcomes. Physical
restraints can be more effective than human restraint and may be necessary in a
small proportion of infants, toddlers, and preschool children. However, restraint
may also carry its own share of psychosocial complications, including increased
distress, decreased coping, and lasting memories. The risks and benefits of
restraint, as well as alternatives, should be weighed appropriately.
In conjunction with restraint, standard methods of pharmacologic anxiolysis or
sedation and local or regional anesthesia are often indicated. The use of anxietyreduction techniques by trained staff, typically child life specialists, as well as the
continued calm presence of the parents, may be of great benefit to the child.

Complications
1. Erythema, bruising, or edema at points of contact
2. Vascular compromise (restraint too tight or restraint for excessive time)
3. Mistrust and fear at future medical encounters
4. Airway compromise or musculoskeletal injury (rare except in high-risk patients
or with unsafe restraint practice)

Procedure
With good distraction and creative positioning, some children will be able to
complete procedures without physical restraint. Use the examination prior to the
procedure and the period of cleaning and other involvement with the injury to
determine how well the patient may tolerate the procedure. If the child is able to
remain still during these times, you may be able to avoid restraint altogether. By
placing a sheet under the child prior to commencement of the procedure, you can
start with the least amount of restraint, but move to the bundling wrap quickly
should it become necessary.

Positional Support by Caregiver
Often, the separation from a caregiver may evoke a response that sets the
procedure on a difficult course. Child life and other staff may encourage close
positioning of the caregiver (i.e., in the bed next to the child or a chair next to the
bed) so that the child feels more connected and safe during the procedure.
Caregiver presence is often associated with decreased stress, less pain, and