Clarifications on Pneumatic Tourniquet Use

In the recent AORN Journal article, “Back to Basics: Pneumatic Tourniquet Use” (September 2017, Vol 106, No 3), the author provided a concise summary on pneumatic tourniquets that could be used as an introduction and guideline on tourniquet safety and use. Overall, the article is very well written and provides useful information for perioperative readers. The following clarifications and suggestions are offered to correct some minor errors and misconceptions and to add some supplementary information, thus further helping to achieve the author’s commendable goal of improving patient safety.

OPTIMAL TOURNIQUET PRESSURE IS BASED ON LIMB OCCLUSION PRESSURE

The article states that “[l]imb occlusion pressure (LOP) is the pressure required to occlude arterial flow to the limb and should be kept to the minimal effective pressure.”[1] The statement appears to imply that the user can choose different LOPs for an individual patient and the lowest LOP should be selected. However, LOP is defined as the minimum pressure required, at a specific time in a specific tourniquet cuff applied to a specific patient’s limb at a specific location, to stop the flow of arterial blood into the limb distal to the cuff. Limb occlusion pressure is the lowest and safest tourniquet occlusion pressure for the individual, and it accounts for both cuff variables and the patient’s physiological variables (including systolic blood pressure and limb circumference). Therefore, the correct statement should be “tourniquet inflation pressure should be kept to the minimal effective pressure based on the patient’s limb occlusion pressure (LOP). Limb occlusion pressure is the minimum pressure required to occlude arterial flow to the limb.” Learn more about Limb Occlusion Pressure (LOP).

The article also suggested that “[t]o ensure successful procedures involving pneumatic tourniquets, the surgeon or anesthesia care provider should determine the tourniquet inflation pressure based on the patient’s systolic blood pressure and limb circumference.”[1] However, the literature shows that systolic blood pressure does not correlate well with LOP and should not be used to set the cuff pressure[2]. Furthermore, LOP is affected by both cuff width and limb circumference, as well as other anatomic and physiologic characteristics of the patient.[3] Therefore, basing the tourniquet pressure on only systolic blood pressure and limb circumference is outdated, inaccurate, and hazardous, resulting in either excessive or inadequate pressures for arterial occlusion. Instead, it is now commonly recommended that the surgeon or anesthesia care provider should determine the tourniquet inflation pressure based on LOP because it accounts for all of the variables that affect the patient’s occlusion pressure.[4, 5]

STERILE, SINGLE-USE TOURNIQUET CUFFS

In the article, the author provided an excellent summary on the use and reusability of reusable tourniquet cuffs. However, there may have been insufficient information on disposable, single-use tourniquet cuffs, which are more commonly used than their reusable counterparts.

Sterile, disposable cuffs are available for situations that require placement of a sterile tourniquet near the operative site or for use in contaminated surgical procedures. The design and materials of disposable cuffs are suitable for a single sterilization cycle and single use only, and must not be resterilized or reused. If a disposable cuff is selected, it should be discarded at the end of the procedure.

REFERENCES

  1. Spruce L. Back to basics: pneumatic tourniquet use. AORN J. 2017;106(3):219-226.
  2. Younger AS, McEwen JA, Inkpen K. Wide contoured thigh cuffs and automated limb occlusion measurement allow lower tourniquet pressures. Clinical orthopaedics and related research. 2004 Nov 1;428:286-93.
  3. Graham B, Breault MJ, Mcewen JA, Mcgraw RW. Occlusion of arterial flow in the extremities at subsystolic pressures through the use of wide tourniquet cuffs. Clinical orthopaedics and related research. 1993 Jan 1;286:257-61.
  4. Noordin S, McEwen JA, Kragh Jr CJ, Eisen A, Masri BA. Surgical tourniquets in orthopaedics. JBJS. 2009 Dec 1;91(12):2958-67.
  5. Sharma JP, Salhotra R. Tourniquets in orthopedic surgery. e. 2012;46(4):377-383.
2018-02-05T11:46:18+00:00