SELF-RELEASING PADDED BELTS
Applicable Products:
DESCRIPTION OF PRODUCT: Self-Releasing Padded Belt. For chair or hospital bed use only.
4126V
POSEY SELF-RELEASING
PADDED BELTS
4126Q Quick-Release Buckle in
REF
front
4126V Hook and Loop in front
REF
APPLICATION INSTRUCTIONS: WHEELCHAIR
Before use, check device for damage and that hook
and loop adheres securely. Discard if you have any questions
about patient safety.
1. Position the patient as far back in the seat as possible, with
the buttocks against the back of the chair.
2. Lay the lap belt across the patient's thighs with the foam
facing in.
3. Bring the ends of the connecting
straps down at a 45-degree angle
between the seat and the wheelchair
sides (fig. 1). Criss-cross the straps
behind the chair and draw them
around the opposite side kick spurs
(fig. 2).
4. Secure the connecting straps, out of
the patient's reach, using quick-release
ties. Check that the straps are secure
and will not change position, loosen,
or tighten if the patient pulls on them,
or if the chair is adjusted.
5. The belt must be snug, but not
interfere with breathing. To check for proper fit, slide an
open hand (flat) between the belt and the patient.
6. The patient may release the belt by opening the quick-
release buckle or hook and loop fastener.
APPLICATION INSTRUCTIONS: HOSPITAL BED
1. Bring the belt around the patient's waist with the foam pad
facing in.
2. Cross the straps behind patient, and feed each strap
through the positioning loops on the ends of the blue foam
pad. The belt must be snug, but not interfere with breathing.
To check for proper fit, slide an open hand (flat) between the
belt and the patient.
3. Secure each connecting strap around a movable part of the
bed frame, at waist level, using a quick-release tie. Check that
the straps are secure and will not change position, loosen, or
tighten if the patient pulls on them, or if the bed is adjusted.
© 2009 Posey Company. All rights reserved.
4126Q, 4126V
REF
INDICATIONS FOR USE:
• Patients needing a reminder to call for assistance before exiting a chair
or bed, and are able to follow instructions.
• Patients needing a positioning device for added safety while in a chair
or bed.
• NOTE: This device DOES NOT allow the patient to roll from side-to-
side or sit up in bed. If greater range of motion is desired, see Posey
Catalog for other options.
This product is designed for self-release. If the patient is not able to easily self-
release, it is considered a restraint and must be prescribed by a physician.
CONTRAINDICATIONS:
• DO NOT use on a patient who is or becomes highly aggressive, combative, agitated, or suicidal.
• DO NOT use on patients with: ostomy, colostomy, or G-tubes; hernias, severe Cardio
Obstructive Pulmonary Disease (COPD); or with post-surgery tubes, incisions or monitoring
lines. These could be disrupted by a restraint.
• DO NOT use on a patient who is unwilling or unable to follow instructions, and is at risk of a
fall or re-injury from self-release.
ADVERSE REACTIONS
• Severe emotional, psychological, or physical problems may occur: if the applied device is
uncomfortable; or if it severely limits movement. If symptoms of these problems ever appear for any
reason, get help from a qualified medical authority and find a less restrictive, product or intervention.
FIG. 2
Posey Company • 5635 Peck Road, Arcadia, CA 91006-0020 USA • www.posey.com
Phone: 1.800.447.6739 or 1.626.443.3143 • Fax: 1.800.767.3933 or 1.626.443.5014
Heed these warnings to reduce the risk of serious injury or death:
BED SAFETY
• ALWAYS use Hospital Bed Safety Workgroup (HBSW)
(http://www.fda.gov/cdrh/beds/
modguide.html) compliant side rails in
the UP position and fill ALL gaps to
reduce the risk of entrapment.
• Use side rail covers and gap protectors
to help prevent the patient's body from going under,
around, through or between the side rails. A failure to do so
45 ˚
may result in serious injury or death if a patient becomes
suspended or entrapped. Posey offers a full range of side
rail pads and/or gap protectors to cover gaps.
FIG. 1
• There is a risk of chest compression or suffocation if the
patient's body weight is suspended off the mattress or
chair seat. Use extreme caution with chair cushions. If a
cushion dislodges, straps may loosen and allow the
patient to slide off the seat (figs. 3, 4, and 5).
• Monitor per facility policy to ensure that the patient
cannot slide down, or fall off the chair seat or mattress
and become suspended or entrapped (figs. 3, 4, and 5).
FIG. 3
• STOP USE AT ONCE: if the patient is at risk to slide
forward or down in the device.
NOTE: A restraint with a pelvic piece will help to reduce
the risk of sliding. See Posey Catalog.
• Before leaving the patient unattended, explain the
purpose for the belt. Make sure the patient understands:
the need to call for assistance before exiting the bed or
•
chair; and
how to self-release in an emergency.
•
APPLICATION
INSTRUCTIONS
Rx ONLY
FIG. 4
FIG. 5
ADDITIONAL SAFETY AND LAUNDERING
INSTRUCTIONS ON OTHER SIDE
MDSS GmbH
EC
REP
Schiffgraben 41
D-30175 Hannover, Germany
4126Q
I9246 040609