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NICU guideline identifier

Restraint of infants for treatment or procedures

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Restraint category Form
Application Type of Restraint Watch points / monitoring
Physical  No IV/LL/Peripheral IA Limb immobilised: held by nursing/medical staff during insertion.
Splint applied to limb across appropriate joint to ensure immobility and thus maintenance of therapy lines. 
Hourly site checks
Physical  No UAC/UVC insertion Restrained in folded nappies as per instructions below for duration of insertion. Cardiac/SpO2 monitoring.
Frequent checks of infant.
Physical  No Lumbar puncture Infant held on side with spine curved to enable safe insertion of spinal needle.
Occasionally infants may be held sitting flexed forward. 
Protection of airway paramount
Appropriate respiratory support commenced before procedure commenced 
Cardiac/SpO2 monitoring if appropriate
Physical / chemical No Intubation Infant held still with neck extended to facilitate rapid safe intubation of airway.
Sedated/muscle relaxed with medication to aid correct insertion of ET tube easily. 
Cardiac/SpO2 monitoring
Physical  No Chest drain insertion Infant held on side with limbs immobilised to facilitate insertion of trochar into pleural space.
Infant sedated and local anaesthetic used as appropriate.
Cardiac/SpO2 monitoring
Physical  No Transports Infant transported in appropriate equipment according to gestation and complexity of care required:
Transport incubator: infant restrained in harness to ensure safety while travelling via ambulance/aircraft.
Cot: infant restrained with harness within cot and appropriate restraint of cot in ambulance.
Car seat: infant restrained with appropriate harness and seat-belt to ensure safety during transport.
Infant's comfort and safety paramount
Appropriate monitoring for gestation and complexity

Restraint for Umbilical Artery or Venous Catheter Insertion

Restraint of Arms

  1. Using a cloth nappy fold top right hand corner diagonally into the middle, to form a triangle.
  2. Fold the opposite corner into the middle to meet the first fold.
  3. Fold the bottom edge up approximately 10 cm to form a pouch.
  4. Place infant on folded nappy.
  5. Place infant's hands by the side and into the pouch.
  6. Fold the right top corner down onto the chest.
  7. Fold the bottom right corner up over the chest and tuck under the infants right shoulder. Keep the umbilical area exposed.
  8. Repeat for the left side.

Restraint of Legs

  1. Using a cloth nappy fold top edge down approximately 10 cm. Slide folded edge under infant to waist level.
  2. Keeping legs in a comfortable position, wrap the legs to keep umbilical area exposed.
  3. Secure nappy by tucking excess under mattress at base of heat table.
  4. For large babies place a towel across the legs and tuck under each side of the mattress.

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Document Control

  • Date last published: 24 April 2007
  • Document type: Clinical Guideline
  • Services responsible: Neonatology
  • Owner: Newborn Services Clinical Practice Committee
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years