A historical comparison of the success rates and viability of venipuncture in restless patients with differential restraint methods in clinical nursing

Background: Agitated patients in emergency settings face challenges during venipuncture due to unpredictable limb movements, leading to procedural failures and injuries. Physical restraint methods are commonly used, but comparative data on their efficacy, time efficiency, and clinical outcomes remain limited. Methods: This retrospective study analyzed data from 387 agitated patients requiring upper limb venipuncture in an emergency department (January 2022–December 2024). Patients were categorized into three restraint groups: elastic band fixation (n=137), splint-band fixation (n=122), and manual hand-holding (n=127). Key outcomes included first-attempt success rate, total procedural time, fixation stability, and complications. Results: Device-based restraints (band and splint groups) showed significantly higher first-attempt success rates compared to manual restraint (P<0.05), with no notable difference between the two device groups. Repeated puncture attempts were more frequent in the hand-holding group (P<0.05). The band group required the shortest total operating time, while the splint group demonstrated superior stability (lowest loosening incidence: 9.8% vs. 29.4% ecchymosis in the manual group). Pain scores were comparable across groups, but splint users reported better comfort. Conclusion: Splint-band fixation offers optimal stability but demands longer setup time and additional personnel, limiting its practicality in urgent scenarios. Elastic band fixation balances efficiency and success, making it preferable for emergency use. Manual restraint suits mildly agitated, cooperative patients but requires backup strategies. A tiered restraint protocol, tailored to agitation severity and clinical urgency, is recommended to improve outcomes and patient safety.