The intention to use physical restraints to prevent self-extubation or accidental removal of lines or tubes is often misguided. In fact, some research has found restraints have the potential to cause harm to critically ill patients, including complications but not limited to unplanned extubation, increased risk for delirium, and prolonged recovery. The use of physical restraints in ICU patients in Canada is common and significantly higher comparable to some European countries. Guidelines recognize the paucity of evidence to substantiate the use of physical restraints as an effective strategy. The use of physical restraints can be minimized by maintaining direct visual observation of patients, permitting the presence of family care partners, initiating spontaneous awakening and breathing trials (to support removal of endotracheal tube and thus reduce need for restraints), and assessing delirium and the need for mobilization. Decreased use of physical restraints is an important indicator of quality nursing care. For more information:
Alberta Health Services. Restraint as a last resort – Critical care [Internet]. 2018 Feb.
Da Silva et al. Unplanned endotracheal extubations in the intensive care Unit: Systematic review, critical appraisal, and evidence-based recommendations. Anesthesia and Analgesia. 2012;114(5). PMID: 22366845.
Devlin J. W., et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Critical Care Medicine. 2018;46(9): e825-e873. PMID: 30113379.
Luk E, et al. Predictors of physical restraint use in Canadian intensive care units. Critical Care. 2014 Mar;18(2):R46. PMID: 24661688.
Maccioli GA, et al. Clinical practice guidelines for the maintenance of patient physical safety in the intensive care unit: Use of restraining therapies–American College of Critical Care Medicine Task Force 2001-2002. Critical Care Medicine. 2003;31(11): 2665-2676. PMID: 14605540.
Minnick AF, et al. Prevalence and variation of physical restraint use in acute care settings in the US. J Nurs Scholarsh. 2007;39(1):30-7. PMID: 17393963.
Physical Restraints for the Prevention of Self-Extubation or Line or Tube Removal in Critically Ill Patients: Clinical Effectiveness and Guidelines. Ottawa: CADTH; 2019 May. (CADTH rapid response report: summary of abstracts).