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TOURNIQUET USE

TOURNIQUET USE. 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.

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TOURNIQUET USE

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  1. TOURNIQUET USE

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

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