The effects of wrist and elbow restrictions on vascular complications and agitation in mechanically ventilated children: a randomized crossover trial.

Abstract

Background: Physical restraints are required in pediatric intensive care units, with wrist restraints commonly used for mechanically ventilated children. However, they may contribute to pressure-related complications and agitation. This study compared the effects of wrist and elbow restraints on vascular complications and agitation in mechanically ventilated children.

Methods: A randomized crossover clinical trial was conducted between August 2022 and May 2023 in a PICU. Mechanically ventilated children aged 6 months to 7 years were randomly assigned to two groups. Group A received elbow followed by wrist restraint, whereas Group B received the reverse sequence. Palm temperature, radial pulse rate, hand edema, erythema, and agitation were assessed before, during, and after each intervention. Data were analyzed using SPSS; p<0.05 was considered statistically significant.

Results: Forty-eight children were included. Elbow restraint resulted in a greater reduction in hand edema than wrist restraint (p=0.008). During the first intervention period, palm temperature was higher and hand edema and erythema were lower with elbow restraint (p<0.05). Overall, no significant differences were observed between restraint types in palm temperature, erythema, radial pulse rate, or RASS scores (p>0.05).

Conclusion: Elbow restraint may be a suitable alternative to wrist restraint for short-term use in mechanically ventilated children. Further research is needed to establish the safest restraint practices for prolonged use.

Implications for practice: Elbow restraint may be considered when upper-limb restraint is required without restricting trunk movement. Alternating restraint sites may help limit local tissue effects but requires further evaluation.