What are Internal Tourniquets?

A recent US patent for an ‘internal tourniquet for surgery’ [1] described innovation that opens the door to extending tourniquet-related concepts to surgical procedures not previously amenable to conventional tourniquets, especially procedures near truncal-extremity junctions, including hip and shoulder regions, and in the deep abdomen. Synergies exist by integrating this internal tourniquet innovation with related [...]

Tourniquets for Treating Open Fractures and Traumatic Injuries: Contraindicated or Not?

Overview: A current overview of the use of tourniquets in surgery and traumatic injury is provided elsewhere [1]. Open fractures: The use of a tourniquet is contraindicated in the surgical treatment of open limb injuries because it is necessary to make an assessment of the devascularized zone of injury for the purpose of wound management [...]

Tourniquet Injuries: Mechanisms and Prevention

Surgical Tourniquet Injuries It is reliably estimated that pneumatic tourniquets are used in more than one million surgical procedures annually in North America. The potential for injury is significant, although the use of lower, personalized tourniquet pressure levels and shorter tourniquet times are reducing the number, nature and extent of reported injuries. Injuries resulting from [...]

Tourniquet Cuff Selection

In the United States, pneumatic tourniquet cuffs are regulated as Class I medical device by the Food and Drug Administration (FDA). Risks of injuries to patients and legal liability for users arise from use of a pneumatic tourniquet cuff not meeting the FDA requirements. Therefore, it is important to only use pneumatic tourniquet cuffs that [...]

Safety Considerations During Use

The following should be considered during tourniquet use to reduce the risk of tourniquet-related complications: Intraoperative monitoring Tourniquet deflation Bilateral procedures Intravenous Regional Anesthesia procedures Documentation Troubleshooting Intraoperative monitoring Intraoperative monitoring of tourniquet safety parameters reduces the risk of complications. During the procedure, it is important to monitor the patient's blood pressure, tourniquet pressure, and [...]

Preoperative Patient Assessment

Patient Assessment The perioperative staff should assess the patient preoperatively for potential contraindications and risks [1]. The final decision on whether or not to use a tourniquet rests with the attending physician. Potential contraindications for tourniquet use Perioperative staff should screen the patient preoperatively for the following potential contraindications [1]: Venous thromboembolism, Impaired circulation or [...]

Pediatric Tourniquets

Pediatric patients are different from adult patients in that they have smaller limb circumferences and limb lengths, different mass of muscle and other soft tissues, and different physiological characteristics such as blood pressures and heart rate. These characteristics can vary greatly within the pediatric population from neonatal to adolescent patients. To ensure safe and effective [...]

Military and Pre-Hospital Tourniquets

There are two types of tourniquets used in military and pre-hospital settings: Pneumatic tourniquets, Non-pneumatic (non-inflatable) tourniquets While both types of tourniquets can be used to stop bleeding in military and pre-hospital settings to save a life, pneumatic tourniquets provide greater safety to the limb because they can occlude arterial blood flow at lower pressures, [...]

Intravenous Regional Anesthesia (IVRA)

What is Intravenous Regional Anesthesia? Intravenous regional anesthesia is a tourniquet-related alternative to general anesthesia for limb surgeries. It is inexpensive and widely used for both adults and pediatric patients, with the frequency varying by the type of surgery and practice patterns [1]. In IVRA, a dual-bladder cuff or two single-bladder cuffs are applied proximal [...]

10 Best Practices for Surgical Tourniquets (2017)

Further reading:Preoperative patient assessment2015 AORN guideline Further reading:Tourniquet cuff technologyTourniquet cuff selectionFDA requirements for pneumatic tourniquets in the United States Further reading:Tourniquet cuff technologyMaintenance, cleaning, and reprocessing Further reading:Tourniquet cuff technologyMaintenance, cleaning, and reprocessing Further reading:Tourniquet cuff technologyTourniquet cuff application Further reading:Tourniquet cuff technology Further reading:Limb Occlusion Pressure (LOP)Tourniquet instrument technology Further reading:Safety considerations during [...]