Thrombosis associated with physical restraints

Abstract

Objective: Physical restraint is controversial, but still frequently used in psychiatric units. We describe two cases of thromboembolic phenomena, one with a fatal outcome, in association with physical restraint. Method: The world literature on physical restraint and thrombosis was reviewed by undertaking a search of electronic databases. Results: To our knowledge, we are the first to report thrombosis associated with physical restraint. Conclusion: Immobilization and trauma to the legs while restraining a patient are adequate explanations for the occurrence of thrombosis. Special attention should be paid to thrombosis when employing restraints in psychiatric wards. Further systematic research into physical restraints in psychiatry is clearly needed.

Use of mechanical and pharmacological restraint over an eight-year period and its relation to clinical factors

“…Still, there are reports on unwanted effects such as prolonged admittance, pressure sores, psychological traumas, and even death [11,[13][14][15][16][17]. Executing coercion and restraint is also stressful for the health-care personal.…”

Deep venous thrombosis and pulmonary embolism in psychiatric settings

“…The literature search revealed three psychiatric conditions with an increased risk of DVT or PE: physical restraint, catatonia, neuroleptic malignant syndrome (Table III) [32][33][34][35][36][37][38][39][40][41][42][43][44][45] .…”

“…In the English literature we found 6 cases of patients who developed a DVT or PE during physical restraint, listed in Table III [32][33][34][35] . Physical restraint was usually applied in a suspine position with a waist belt or fourpoint restraint of the wrists and ankles.…”

“…In most of the cases risk factors other than physical restraint for VTE were present, with exception of the case report of Laursen et al 35 . In two cases, the patients were complaining of chest pain or respiratory difficulties for several days, ascribed to anxiety or psychosis, before the correct diagnosis was made 32,35 . Two patient collapsed shortly after the restraints were removed 32,34 and one patient died 24 hours after removal of the restraints 33 .…”

Use of Physical Restraints in Neurosurgery: Guide for a Good Practice

“…One hundred deaths in the USA occur annually in addition to higher hospital infection rates and injuries by improper physical restraint. Moreover, patients under physical restraint lost muscle strength, had pressure ulcers, incontinence, strangulation (Taylor et al, 1997), and were severely agitated, confused, depressed, angry, fearful, confused, panicked, and experienced sleeping difficulties, loss of role, shyness, body disformation, resistance or objection to daily routine activities, higher disorganized behaviours, cognitive and behavioural problems due to changes in blood chemistry, and loss of self-trust and respect (Bonner et al, 2002;Bray et al, 2004;Cannon et al, 2001;Castle, 2002;Choi & Song, 2003;Evans et al, 2002Evans et al, , 2003Hem et al, 2001;Koch & Lyon, 2001;Shorr et al, 2002;Swauger & Tomlin, 2000). Avoiding physical injuries by physical restraint is only possible through improved quality of care Over the last 20 years there has been an increasing evidence supporting the reduction of restraints' use of.…”