1. TOURNIQUET USE

2. HISTORICAL PERSPECTIVE
Ancient Greeks- compression devices
1718 – Dr. L Petit, developed screw device.
Where name came from, french verb “tourner” (to turn)
1904 – Harvey Cushing developed inflatable device.
1908 – August Bier administered segmental anesthesia
Zimmer, 1997
HISTORICAL PERSPECTIVE

3. PRE-OPERATIVE ASSESSMENT
Planned location
Relative Contraindications
Extremity infection
Open fracture
Impaired circulation/ Compartment Syndrome
Extremity with dialysis access (AV shunt, fistulas)
Size and Shape of Extremity
Condition of skin
Peripheral pulses
AORN Perioperative Standards and Recommended Practices, 2012

4. Alexanders Care of the Patient in Surgery, 2011
Touniquet Machine
Set-up
Pressure settings
Determined by Surgeon
Guidelines: Healthy adult settings
300 – 350mm Hg for thigh
250– 300mmHg for arm and lower leg
Time
Adult – Upper ( 1 hr), Lower ( 2 hr)
Interval of deflation equal to 5min /30min of time
Generally set to alarm after 60 minutes
Alexanders Care of the Patient in Surgery, 2011
PRESSURE AND TIME

5. TOUNIQUET CUFF Cuff Correct Cuff Choices General rule of thumb:
Overlap of 3” minimum and 6” maximum
Application principles
Avoid compression of bony or superficial neurovascular structure
Soft padding w/o wrinkles, especially thin extremities
Do the ‘traction hold’ for cone-shaped extremities
Be aware of shearing- if need to change position
Protect skin under cuff from prep solution/fluid
AORN Perioperative Standards and Recommended Practices, 2011

6. ASSESS FOR POTENTIAL COMPLICATIONS
Change in Blood pressure after deflation Metabolites Shunting of blood to extremity Long Tourniquet Time – Increased risk of PE/ Neurovascular complications Bier Block - Early deflation – Risk of dumping local anesthetic into bloodstream. (Ringing in the ears, metallic taste, seizures)
ASSESS FOR POTENTIAL COMPLICATIONS

7. Antibiotics infused before inflation Use of Esmarch Single- cuff use More common Dual-cuff use (Bier Block) Generally deflated incrementally Assess for complications when deflated
TOURNIQUET USE IN OR

8. DOCUMENTATION Documentation of Use: Site Pressure
Duration including Inflation/ Deflation times
Serial # of Tourniquet Machine
Perioperative assessment of extremity
DOCUMENTATION