Medical restraint

In medicine, the concept of fixation is used in different areas or covers. He called:

Fixation of a person

The fixing of a person often takes place in a psychiatric emergency situation that poses a high risk of injury to the person and is often perceived by stakeholders as great exposure. When fixing the patient is fixed by means of special belts lying on his back in bed, so that internal and external hazards are excluded.

Legal requirements

Implementation

The patient is explained the reason for the fixation. It serves to protect himself or others, and is not a punishment dar. Sufficient trained personnel must be available, which precludes fixation in home care in general. Is expected in the implementation of the fixation with strong resistance, the actors have to be in terms of forces in the superior power to avoid a fight and precisely that damage is to be avoided by the fixation. The patient is in the care or hospital bed or in a wheelchair or nursing chair so strapped that security is there escape or accidents. Exist for this purpose specially developed belt systems. Once you know how the patient behaves in the fixation, one can subsequently increase the degree of freedom of the belts gradually or remove individual belts throughout. The use of net beds is more common in Austria than in Germany.

When fixing the bed is graded according to need doing, to achieve the goal of fixation with the least possible movement restriction can.

With a single waist belt of the patient is fixed to a point. The method guarantees high freedom of movement, but is not in itself aligned safe and carries the risk of fatal accidents involving strangulation if the patient slips out of the bed. Therefore, in addition bed side parts are attached. The risk of accidents, as elsewhere encountered in the fixation of the sick, by constant, close monitoring.

In the diagonal fixation of the body is fixed at three points: abdomen, right arm and left leg or left arm and right leg. The method provides for a certain freedom of movement. In a five-point fixation of the body is also fixed to the two remaining free extremities. Shoulder and thigh fixation, the freedom of movement, if necessary, be further minimized.

Alternatives

Fixation is a last resort when a situation different is not controllable and alternative courses of action are no longer available. The protection provided by subpoena protection can be used to treat the underlying disease and bring about a solution without using force. The reassurance of a sick person but can also be caused by "talk down" or anxiolytics. As one of the fundamental rights massively restrictive measure the fixation is with the center of the criticism of current practice in nursing and care (violence in nursing, nursing scandal ). The Werdenfelser way is a newer procedural approach to reduce custodial measures in nursing homes.

Especially old people with dementia are fixed in order to avoid falls. However, the fixation performs the associated immobilization on a permanent basis to a decrease in muscle mass and further deterioration of the movement ability of the person concerned. Therefore, it is not a long term solution. The fixing of dementia continues to be problematic, because it increases the uncertainty of the patient. The dementia perceives the fixation, but can not understand the context. Alternatively, other methods can be applied, which serve to prevent accidents and make the environment safer. Beds can be driven down to almost to the ground with a suitable design, what the possible fall height reduced. The floor can be cushioned, view technical reporting systems when the dementia will rise. The offering of activity, good lighting and the removal of tripping hazards contribute to the prevention of falls. The use of hip protectors reduce their consequences. The case law in a particular case highlights an example of the variety, be weighed against each other aspects in the prevention of accidents.

Fixation ( degree of disorder )

Degree of irreversible disease (eg fixed Pulmonary hypertension leading to Eisenmenger's reaction).

Fixation in histology

In histology tissue sections must be fixed prior to staining first (see fixation ( method of preparation ) ).