Medical situations in which restraints are used?
May 11, 2010 11:38 AM   Subscribe

As a claustrophobic person, I'm really dislike feeling trapped. One topic that always grabs my attention is stories of people being restrained in medical situations. While Googling tells me that restraining patients is rare, I find some anecdotes: arms strapped down before surgery, thermoplastic masks attached to tables for radiation treatment, vacuum pillows, wrist restraints while on a ventilator... So, to satisfy my odd curiosity, can you help me compile a list of situations in which a person might find themselves physically stuck?
posted by specialfriend to Health & Fitness (30 answers total) 4 users marked this as a favorite
When you get an MRI typically you are velcro-strapped down to minimize movement. I get brain MRI's so then I usually have a sort of football helmet mask type thing pulled down over my face and my foreheard taped, too. None of it hurts, it's just to minimize arm folding and neck movements, etc.
posted by ShadePlant at 11:40 AM on May 11, 2010 [1 favorite]

My wife had her arms and (I think, it was covered by a sheet) torso strapped down before her C-section. She made a joke about Dead Man Walking because nothing is funnier than lethal injection jokes during the birth of one's child.
posted by bondcliff at 11:44 AM on May 11, 2010 [3 favorites]

I've had a number of MRIs, and I've never been restrained for them.

You are restrained during a tilt test, which tests for syncope or other things. You are strapped to a table. You are kept horizontal for a while, and then tilted vertically to test if you pass out after still for too long. I lasted 12 minutes.

Some people request restraints when giving blood because they can't keep still or prevent themselves from reacting. My mother is a phlebotomist, and it is more common than you'd think.
posted by Lizsterr at 11:47 AM on May 11, 2010

I'm not sure it's completely what you're after, but trauma to vertebrae in your neck often leave you in a halo, which completely restrains your neck and head movement.
posted by Hiker at 11:50 AM on May 11, 2010

Er, that's supposed to be " test if you pass out after standing still for too long." Sorry!
posted by Lizsterr at 11:50 AM on May 11, 2010

I worked in a mental institution as an orderly, basically, and we would restrain patients who were acting out violently (hitting or trying to hit other patients or staff, self-harming, etc.) so we could give them shots of thorazine and get them to stop. It was usually three or more of the men working on the floor pinning them to the restraint table and strapping in their arms and legs while the nurse prepped the shot.

Not one of my more pleasant set of memories...
posted by dubitable at 11:55 AM on May 11, 2010

Typically whenever you're transported in an ambulance, you're going to be strapped to a gurney.

And, I too worked psych wards for a lot of years... and, for about 20 years afterwards, carried a standard restraint lock key with me, just in case....
posted by HuronBob at 11:57 AM on May 11, 2010

The elderly are restrained in cases of dementia and severe Parkinson's, when feeding them and occasionally when they sleep to prevent them falling.

Babies are swaddled after birth.
posted by watercarrier at 11:58 AM on May 11, 2010

Heh, coincidentally, I'm studying to take my CNA exam and was just on my textbook's section on restraints. In a nursing home, restraints may be applied for these reasons:
--To keep a person from injuring self or others
--To keep a person from pulling out tubing that is needed for treatment
--To keep a person with dementia or who is confused from wandering
--To prevent falls

Restraints are to be viewed as a last resort, and facility staff are trained in a lot of methods to try to prevent needing them. They are applied only with a doctor's order, and a restrained patient has to be checked every 15 minutes for skin/circulation/bathroom, and released for 10 minutes every 2 hours.

Restraints aren't just leather straps either, the same guidelines apply to chemical restraint (sedatives) or anything that makes a patient feel trapped. If, for example, you're in a wheelchair and feel trapped by your bedside table, a facility staff member needs to remove it ASAP and talk to you until you're ok with the situation.
posted by TungstenChef at 12:16 PM on May 11, 2010 [1 favorite]

When I had my jaw broken, for the surgery they had to strap my arms straight out in the cross position. Then they intubated me through my nose, and had to try it three times. My back was bruised from slamming it into the table during that whole thing.

I had nightmares about it for about a year afterwords.
posted by lumpenprole at 12:17 PM on May 11, 2010

I got a backboard with straps and a cervical collar after a car accident, and once as a patient transport demo victim in my First Responder class (that also involved head bolsters).

You're definitely not going anywhere unless a couple someones pick you up and walk off with you in that event.
posted by fairytale of los angeles at 12:18 PM on May 11, 2010

I was strapped down when I had some operations under general and twilight anesthesia. If you're intubated, you need to be really still.

My then 1-year-old daughter was restrained in a papoose-type apparatus when she had to get Dermabond applied to her ear to close a wound. It kept her from touching the site during the application or drying period.

Heck, babies and small children are restrained all the time--in car seats.
posted by FergieBelle at 12:24 PM on May 11, 2010

The first and only time I tried skiing was on a class trip to Quebec. On one of my first attempts I fell off the chairlift headfirst, broke my wrist, and had to be strapped to a bright orange rescue sled and carted down by ski patrol while everyone in my 8th grade class stared. It's probably the least fun I've ever had in a sled.
posted by soft and hardcore taters at 12:28 PM on May 11, 2010

IIRC, patients are awake during brain surgery, but presumably physically locked down to prevent movement while the surgeon is cutting. And of course the classic cartoon injury consequence, a full body cast.
posted by nomisxid at 12:34 PM on May 11, 2010

- When I got an MRI my head was placed in a plastic basket sort of thing to keep me from moving it. The process takes a while and you have to stay really still so the image doesn't blur and become useless. This may also be true with some x-rays
- When you have a mammogram your breast gets smushed between two plates [some people find this horrible, I didn't find it too bad] and you have to stay still
- if you are in an accident and they think you may have broken your neck/back, you need to be put in a cervical collar which reduces your head mobility
- probably not what you were looking for but if you have an IV you are sort of attached via tube to an IV stand or wherever the liquids are. There are a lot of things that attach you to things but do not immobilize you [heart monitors, EKGs, catheters, that sort or thing]
- when I was in a car accident and put on a ventilator [long story] I was... ornery when I woke up [I do not remember any of this] so they strapped me to the table using arm restraints. These were removed once I woke up and was no longer ornery.
- people in psych wards and on suicide watch are sometimes restrained
- MAST pants

In many cases, though certainly not all, being clear that you are phobic and explaining that you promise not to freak out if given more minimal restraints is the way to go. The problem is that a lot of times this works out where someone is given low-level restraints which scares them and then they freak out and wind up in heavier restraints.
posted by jessamyn at 12:34 PM on May 11, 2010

I once did a medical research study that involved having an intravenous infusion apparatus in one arm (with a big-ass needle/cannula that reminded me of a sharpened coffee straw), a heparin lock (needle device that stays in a vein to allow multiple blood draws without repeated sticks) in the other, EKG leads all over my chest and torso, an oximiter clipped on my finger, and a brain wave cap. It might not technically be "restraint", but suspended between all those wires and a giant needle in each arm, I wasn't going anywhere. I joked that it was enough to give a person a panic attack.

Ironic, because the fun was yet to begin: the purpose of the study was to deliberately induce a panic attack with an intravenous sodium lactate infusion. Good times!!

The investigator said I took it better than anyone he'd ever seen...I reasoned my way through it by telling myself that even though I felt like I might be dying, nothing bad was going to happen since I had all these monitors on and a roomful of people around me. Chalk it up to being accustomed to quietly freaking out, I suppose.
posted by aquafortis at 12:36 PM on May 11, 2010

The Milwaukee Brace. The end-all of all contraptions designed to keep one's body (spine in particular) constrained. Talk about *fun times*. You wear it 23/7/365 in cases of scoliosis.
posted by watercarrier at 12:43 PM on May 11, 2010

In an operating room, you're generally strapped to the table with a velcro strap to keep you from falling off. The tables are really narrow, barely as wide as a human body, because it lets the surgeons get in close. Often the arms will be strapped down on planks out to the side, too, to allow for easy IV access. If you're having gyno surgery, your legs will also be strapped to the stirrup arms that keep your them out of the way. The patient will often be awake for most of this. But like most of the "restraints" described above, the purpose is to keep you from accidentally moving somewhere you're not supposed to, rather than to prevent you from choosing to move.

My dad had soft restraints put on his wrists for a few days after having an implanted pacemaker put in, because raising his arms over shoulder level could dislodge the pacemaker wires during the early healing process. Most people could just remember not to do that motion, but he was still confused due to the low brain oxygen during his heart attack and kept trying to cross them up behind his head. It's not like his arms were strapped tight to the bed, they were just on "leashes" that were too short to allow his arms above the shoulders. The nurses tried nearly everything before resorting to that option, because physical restrains are really frowned upon in the hospital. They reminded him over and over and over, tried to give him things to do with his hands to keep him occupied, etc. but unfortunately it didn't work.

Little kids will often get "elbow boards" strapped to the back of each arm, either to prevent them from bending the elbow if there's an IV nearby or to keep them from scratching at things on their torso or face. It's kind of weird, but try scratching at your eye/ear/face/chest without bending your elbows. Impossible! But you can still grab stuff, move around, etc., so it's much less restraining than a tie-down would be.
posted by vytae at 12:52 PM on May 11, 2010

One of the worst ways to be trapped...if the paramedic/doc needs to get an airway they will use an ET tube. When they do this, the cardinal rule is to knock the patient out first then paralyze them (chemically). Paralyzing them first can't be a good feeling for the patient.
posted by MsKim at 1:13 PM on May 11, 2010

As a child, I was strapped/taped to a hospital bed on two separate occasions while receiving stitches because I was so scared. Both times I was being stitched on my face.
posted by alice ayres at 1:17 PM on May 11, 2010

Attachment Holding Therapy - a child is firmly held (or lain upon) by therapists or parents. Through this process of restraint and confrontation, therapists seek to produce in the child a range of responses such as rage and despair with the goal of achieving catharsis.
posted by watercarrier at 1:24 PM on May 11, 2010

Nth the MRI head restraint. That's actually how I found out I was claustrophobic.

Little kids will often get "elbow boards" strapped to the back of each arm

I had a elbow board strapped to my arm to keep it immobile while I got ~50 stitches for a deep cut when I was ~9. Also had several orderlies sitting on me. Fuckers.
posted by anti social order at 1:24 PM on May 11, 2010

I had minor surgery on my arm, and they strapped that fucker down like nothing I've ever seen. Everything else was loose. But that arm was going nowhere.
posted by Cool Papa Bell at 1:35 PM on May 11, 2010

Oh, almost forgot...a "squeeze box" for autistic people.
posted by MsKim at 2:36 PM on May 11, 2010

Nthing the child panic-restraint. I had a head wound that needed stitches. Nothing serious, really, but I freaked and had to be restrained by what I remember as almost a full sleeping bag. Of course I promptly freaked out even harder by that.
posted by joemax at 6:00 PM on May 11, 2010

I had a long haul flight where I had an anxiety attack during meal service-- trays down, middle seat, and turbulence (which I have concluded MUST occur during meal service). I actually passed out. Now I have to take Xanax when I fly.
posted by holterbarbour at 6:27 PM on May 11, 2010

I had really minor surgery on my leg once and they strapped me down and basically covered me in sheets and blankets to the point where I pretty much couldn't move and had my arms at my sides. The only things that were exposed were the leg in question and my head.

The local anesthetic they gave me hadn't fully kicked in when the incision was made, so I inadvertently tested how well I was restrained when I jumped and shrieked. Answer: pretty well.
posted by cmgonzalez at 8:34 PM on May 11, 2010

I just want to reiterate something that HuronBob (and a few others) mentioned, because it is maybe the most common(?) occurrence. Ambulance rides. I've only had one in my life (*knock wood*), and the only thing I remember from it was the feeling of straps tightening around my arms and torso.
posted by zoinks at 8:56 PM on May 11, 2010

My vented (on a ventilator) patients are always strapped down with both wrists in soft restraints tied to the bedframe unless they are paralyzed or awake and complying with instructions (and if I trust them....Great story of a patient who nodded and wrote that she would not pull her tube when the nurse was out of the room, but five seconds after he left the woman had self-extubated. He walked back in, and in a hurt voice said, "But you promised...." to which she replied, in a hoarse whisper, "I li-i-i-i-ed!").

The crazies (usually detoxes or ODs) get 4-point locking restraints. Seems like tying someone down by only their arms makes them even better at kicking you.
posted by nursegracer at 11:13 PM on May 11, 2010

Generally, during surgery (full anesthesia) they knock you out before strapping you down. Most of the time you only know you've been strapped by the little belt marks on your arms, if that.
posted by Sophie1 at 2:44 PM on May 12, 2010

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