Common Medical Wrist Restraint Types

Medical Wrist Restraints

Medical wrist restraints, also known as medical limb restraints or limb holders, are designed to limit the movement of a patient’s wrists. These devices are intended for use with patients assessed to be at risk of disrupting life-saving treatment, compromising wound site integrity, pulling lines/tubes, exacerbating skin conditions, or self-injury.

Today there are a variety of wrist restraints available to professional caregivers working in medical and behavioral health settings. This article provides an overview of several common types of medical wrist restraints. 

The information shared here can be understood to apply to medical ankle restraints as well.

Classifying Physical Restraints

Over the years, the binary concept of “soft restraints” versus “hard restraints” has become a convenient way for caregivers to categorize various restrictive devices. However, such devices can actually be seen to fall along a continuum. In fact, even the exact same device can be perceived differently based on situational context.

Note that the U.S. Centers for Medicare and Medicaid Services (CMS) does not classify devices as soft restraints or hard restraints. Instead, CMS defines two distinct types of patient behavior that could warrant the use of restraint or seclusion: non-violent, non-self-destructive (NVNSD) behavior and violent, self-destructive (VSD) behavior.¹

Soft Limb Restraints

Used primarily for medical treatment of patients exhibiting non-violent, non-self-destructive (NVNSD) behavior, cuffs often thought of as being soft restraints offer caregivers a number of different options for limiting wrist movement.

Common Cuff Closure Methods for Soft Limb Restraints

• Buckle ― Popular soft limb restraints often use a quick-release buckle (an intuitive, plastic two-point press buckle) that facilitates fast cuff application and release while allowing an adjustable cuff circumference.
• D-Ring ― Some soft limb restraints use a standard metal D-ring or a cinch-style metal D-ring with a sliding metal buckle for cuff closure.
• Hook & Loop ― Other soft limb restraints use a hook-and-loop fastener to close the cuff (press to apply, peel to release).

Common Materials for Soft Limb Restraints

Soft limb holders designed to limit the movement of a patient’s wrists typically feature cuffs made from quilted material, foam, or cotton flannel. These devices do not use locking mechanisms (e.g., key locks).

Soft/Hard Limb Restraints

Non-locking limb holders designed to withstand patients that put more strain (exert greater pull force) on restrictive devices are available, too. Such “heavy-duty cuffs” are used both for medical treatment of patients exhibiting non-violent, non-self-destructive (NVNSD) behavior and for treatment of patients exhibiting violent, self-destructive (VSD) behavior. These limb holders might be thought of as being either soft restraints or hard restraints by caregivers.

Common Cuff Closure Methods for Soft/Hard Limb Restraints

• Buckle ― As seen with soft limb restraints, popular soft/hard limb restraints often use a quick-release buckle (an intuitive, plastic two-point press buckle) that facilitates fast cuff application and release while allowing an adjustable cuff circumference.
• D-Ring ― Alternatively, some soft/hard limb restraints use a D-ring consisting of a pair of metal rings for cuff closure that also allows the cuff circumference to be adjusted.
• Hook & Loop ― Other soft/hard limb restraints use a wide hook-and-loop fastener that provides increased strength between hook and loop (press to apply, peel to release).

Common Materials for Soft/Hard Limb Restraints

Heavy-duty, non-locking restraint cuffs like those discussed here may use construction elements such as neoprene fabric, nylon straps, and reinforced stitching to provide extra strength² and durability.

Hard Limb Restraints

Used primarily for treatment of patients exhibiting violent, self-destructive (VSD) behavior, heavy-duty cuffs with locking mechanisms are often thought of as being hard restraints. Such devices typically provide a key lock on the strap that anchors the restraint system to the bed or stretcher.

Common Cuff Closure Methods for Hard Limb Restraints

• Key Lock ― In addition to having a key lock on the anchor strap, popular hard limb restraints often use a second key lock for cuff closure to provide yet another measure of security.
• Buckle ― Some hard limb restraints use a quick-release buckle (an intuitive, plastic two-point press buckle) that facilitates fast cuff application and release while allowing an adjustable cuff circumference.
• D-Ring ― Other hard limb restraints use a D-ring consisting of a pair of metal rings for cuff closure that also allows the cuff circumference to be adjusted.
• Hook & Loop ― Another cuff closure method for hard limb restraints is the use of a wide hook-and-loop fastener that provides increased strength between hook and loop (press to apply, peel to release).

Common Materials for Hard Limb Restraints

Like their non-locking counterparts, heavy-duty restraint cuffs with locking mechanisms may use construction elements such as neoprene fabric, nylon straps, and reinforced stitching to provide extra strength² and durability.

When Should Restraints Be Used?

The patient’s current behavior determines whether or not the use of a restraint is warranted; patient condition must also be considered when making restraint-related decisions. Restraint use at hospitals and other healthcare facilities is expected to comply with all applicable guidelines and standards from governing agencies (e.g., CMS¹) and accrediting organizations (e.g., The Joint Commission, TJC³).

When use of a restraint is necessary, the least restrictive potentially effective measure should be the first to be considered. If this option is insufficient, then incrementally more restrictive options can be considered in turn. Restraint use should be discontinued as soon as it is deemed safe to do so.

Future Designs and Innovations

Patient care needs can vary widely in accordance with many different factors. This diversity of needs is often reflected in the features and functions of the medical devices intended to facilitate quality care.

Physical restraints for use by professional caregivers are no exception. For example, as discussed earlier, medical wrist restraints offer hospitals and other healthcare facilities a broad selection of materials, cuff closure methods, strap configurations, non-locking/locking options, and ways to attach the restraint system to a bed or stretcher.

It is anticipated that future device designs and innovations will further improve the ease of use, security, and bed/stretcher compatibility provided by today’s medical wrist restraints.

We encourage you to contact us today to learn more about medical limb restraints.