Factors associated with the use of physical restraint in intensive care patients.

Luana Rosas Zulian,Suely Sueko Viski Zanei,Eliana Cavalari Teraoka,Iveth Yamaguchi Whitaker,Vanessa Yukie Kita Miyasaki,Satomi Mori

doi:10.1590/s1980-220x2018058503571

Abstract

To verify the frequency of physical restraint in patients and the factors associated with its use in the intensive care unit. An observational and prospective study on the use of restraint in patients observed over two days, considering the variables: age and gender, personal and clinical characteristics, devices, adverse event and restraint use. The frequency was verified in three groups of patients with different conditions by applying the Chi-Squared, Likelihood Ratio or Kruskal-Wallis tests. The association of the variables was verified with the Multinomial Logistic Regression. Eighty-four (84) patients participated. Restraint was observed in 77.4% of the 84 analyzed patients, and was more frequent in the presence of sedation, agitation and invasive devices. The chance of being restrained was at least five times higher in sedation conditions, whether in weaning or daily awakening, mechanical ventilation weaning, agitation or the presence of invasive devices. Restraint use was high and was associated with female gender, sedation, agitation and invasive airway. It is emphasized and important to apply policies to reduce restraint use in intensive care.

Highlights

A critical patient’s clinical condition, the complexity of care and the use of specialized therapeutic resources require uninterrupted vigilance in Intensive Care Units (ICUs)
The use of physical restraint (PR) may result in adverse events (AE); it is necessary to evaluate the multidisciplinary team in order to perform the correct technique aiming toward patient safety, which includes deciding the best moment for its application and choosing the material to control the risks related to its use[3]
In a systematic review which analyzed the prevalence of PR in the ICU, the presence of invasive devices, delirium and risk of falling were identified as conditions related to their use in 27 studies[12]

Summary

Introduction

A critical patient’s clinical condition, the complexity of care and the use of specialized therapeutic resources require uninterrupted vigilance in Intensive Care Units (ICUs). In this context, physical restraint (PR) is often applied to protect patients who have behavioral or consciousness changes for risk of falls, trauma, contamination, and displacement of invasive devices such as probes, drains, and catheters, which may result in treatment disruption. 19.0% to 25.3% had complications related to the use of PR, in which hyperemia (16.5% to 22.4%), contusion (2%), ulcer (0.4% to 0.8%) and skin necrosis (0.1%) were observed in analyzing the lesions at the site of the device application for PR. Other studies have indicated additional negative consequences from using PR such as edema, cyanosis, bleeding from venous and arterial catheter removal, irritation, severe anxiety, respiratory complications from chest straps, and death[5,6]

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Discussion

Conclusion