Applying an Elbow Restraint

Goal: The patient is constrained by the restraint, remains free from injury, and the restraint does not interfere with therapeutic devices.

1. Determine need for restraints. Assess patient’s physical condition, behavior, and mental status. Refer to review material in the chapter introduction.

2. Confirm agency policy for application of restraints. Secure nan order from the primary care provider or validate that the order has been obtained within the past 24 hours.

3. Perform hand hygiene and put on PPE, if indicated.

4. Identify the patient.

5. Explain reason for use to patient and family. Clarify how care will be given and how needs will be met. Explain that restraint is a temporary measure.

6. Apply restraint according to manufacturer’s directions:
a. Choose the correct size of the least restrictive type of device that allows the greatest possible degree of mobility.
b. Pad bony prominences that may be affected by the restraint.
c. Spread elbow restraint out flat. Place middle of elbow restraint behind patient’s elbow. The restraint should not extend below the wrist or place pressure on the axilla.
d. Wrap restraint snugly around patient’s arm, but make sure that two fingers can easily fit under restraint.
e. Secure Velcro straps around restraint.
f. Apply restraint to opposite arm if patient can move arm.
g. Thread Velcro strap from one elbow restraint across the back and into the loop on the opposite elbow restraint.

7. Assess circulation to fingers and hand.

8. Remove PPE, if used. Perform hand hygiene.

9. Assess the patient at least every hour or according to facility policy. An assessment should include the placement of the restraint, neurovascular assessment, and skin integrity. Assess for signs of sensory deprivation, such as increased sleeping, daydreaming, anxiety, inconsolable crying, and panic.


10. Remove restraint at least every 2 hours or according to agency policy and patient need. Remove restraint at least every 2 hours for children ages 9 to 17 years and at least every 1 hour for children under age 9, or according to agency policy and patient need. Perform ROM exercises.

11. Evaluate patient for continued need of restraint. Reapply restraint only if continued need is evident.

12. Reassure patient at regular intervals. Keep call bell within easy reach.