Medical restraints are devices or methods used in healthcare settings to limit a patient’s physical movement to ensure safety or the continuity of medical treatment. These interventions range from chemical agents to physical devices that restrict movement. The mitt restraint, also known as a safety hand mitten, is a specific, relatively non-invasive form of physical restraint applied to the hands. Mitt restraints are primarily used when a patient’s behavior poses an immediate risk of harm to themselves, such as interfering with life-sustaining medical equipment.
Physical Characteristics and Function
The mitt restraint is constructed as a large, soft, padded glove that fits completely over a patient’s hand, often resembling a boxing glove. These devices are typically made from breathable materials like mesh or soft fabric, sometimes incorporating padding to prevent gripping. A secure strap, often a hook-and-loop closure or a tether, fastens the mitt around the patient’s wrist, ensuring it cannot be easily removed.
The primary function of the mitt is to eliminate fine motor dexterity and the ability to grip or pinch with the fingers. By covering the entire hand, the mitt makes it difficult for a patient to perform tasks like pulling, picking, or scratching. Unlike wrist restraints, which restrict arm movement by tethering the wrist to a fixed object, mitt restraints generally allow the patient full range of motion of the arm. This design limits only the destructive capability of the hand, allowing for a less restrictive intervention.
Some variations of the mitt include an inspection flap, allowing nurses to quickly check hand circulation and skin integrity without removing the entire device. The bulky nature of the mitt makes fine motor tasks, such as disrupting a surgical dressing or dislodging a tube, virtually impossible. The goal is to protect the patient from self-injury while maintaining as much freedom of movement as possible.
When Are Mitt Restraints Medically Necessary
Mitt restraints are considered a last-resort intervention and are only medically necessary when less restrictive alternatives have failed. Their application is justified when a patient’s behavior presents a direct threat to their own health or safety. The primary use is preventing the disruption of essential medical treatments, such as stopping a confused or delirious patient from pulling out IV lines, feeding tubes, urinary catheters, or ventilator tubing.
Preventing self-inflicted harm is another indication for their use, particularly in patients with severe skin conditions or recent surgical sites. For example, a patient with a dermatological condition might scratch their skin causing a serious infection, or a patient who has undergone eye surgery might rub their eyes and compromise the repair. In these scenarios, the mitt restraint acts as a buffer, making it impossible to apply the manipulation required to cause injury. The medical team must document that all other de-escalation techniques, environmental modifications, or non-restraint interventions were attempted and found ineffective before authorizing mitt restraints.
Required Safety Checks and Monitoring
Because mitt restraints are classified as physical restraints, their use is governed by strict regulatory protocols designed to protect patient rights and well-being. A physician’s order is required before application, and this order is time-limited. For non-violent, non-self-destructive behavior, the order often requires renewal every 24 hours. This procedural requirement ensures the restraint is not used for convenience or disciplinary purposes.
Nursing staff must adhere to a rigorous monitoring schedule, typically checking the patient at least every two hours, or more frequently based on facility policy. These checks must include a thorough assessment of the limb for signs of impaired circulation. This assessment involves checking for changes in skin color, temperature, sensation, and the presence of a pulse distal to the restraint. The skin under and around the restraint must also be inspected for signs of redness, abrasions, or pressure injury.
During scheduled checks, the restraints must be temporarily removed for a short period, typically 15 minutes, to provide necessary care. This time is used to offer the patient hydration, food, and toileting opportunities, and to perform range-of-motion exercises for the restrained limb. Comprehensive documentation is mandatory for every monitoring interval. This documentation includes the patient’s behavior, the rationale for restraint continuation, all assessments performed, and the care provided.
Adverse Effects and Risks
Despite their protective intent, the application of mitt restraints carries several potential adverse physical and psychological consequences. A primary physical risk involves skin breakdown and pressure injury, which can occur if the mitt is not properly positioned or if the patient is not repositioned frequently. If the strap securing the mitt is applied too tightly, it can impede blood flow. This can lead to impaired circulation, nerve damage, and severe injury to the hand.
Psychologically, being physically restrained can cause distress, fear, anxiety, and agitation, potentially worsening the underlying condition. Patients may struggle vigorously against the mitt, which can lead to friction injuries or accidental trauma if they strike themselves or objects. Physical restraint, including a mitt, has been associated with hospital-acquired complications. These complications include increased dependency, decreased muscle strength, and delayed recovery, sometimes prolonging the hospital stay.