Tourniquet

It is a mechanical device used in orthopaedics of providing blood less field during surgery or for controlling bleeding temporarily

Types

• Pneumatic: Automatic/non-automatic
  • Automatic: operates from airline/pump
  • Non-automatic: hand operated pump and a pressure gauge
• non-pneumatic

Headings

• Pre application precautions
• Application
• Safe duration and pressure
• Complications
• Physiological changes

Pre application precautions

• Contraindications
  • Severe infection
  • poor cardiac reserve
  • severe trauma
  • POVD, DVT, Reynaud disease
  • Peripheral neuropathy

Braithwaite and Klenerman mod of Bruner 10 rules

• Apply only in healthy limb
• Size: wide
• Site
• Padding: >= 2 layers
• Skin occlusion
• Pressure Sy+100 for arm, double for thigh
• Time: absolute max 3 hours
• Temperature: avoid heating
• Documentation

Application

• applied at area of limb of greatest circumference
• Wide is more effective (Crenshaw)
• Curved requires less pressure (Pedowitz)
• Padding : several layers of smooth cast padding. Rajpura et al >2 layers decrease result in sig reduction of transmitted pressure
• Obese- pull flesh distally
• Elevate for 2 min/ Esmarch bandage upto 5 cm of T
• No solution under it
• Test gauge checked with mercury manometer. If discrepancy b/w test and t >20mm, discard

Duration and Pressure

• Pressure
  • Reid camp Jacob Dopplar steth, Limb occlusion pressure + 50mm (<250/<300)
• Duration
  • 1-2hours
• (but > 2 hours and pressure >350 lower limb/>250 upper limb increases neuropraxia
• if >2 hours required,better finish off rapidly than deflating 10 min for every 30 min of inflation time

Complications

• Tourniquet Paralysis
  • Increased pressure
  • decreased pressure
  • non anatomical
  • too long
• Post tourniquet syndrome (Bunnel)
  • Edema, pallor, joint stiffness, motor weakness and subj numbness
  • Related to duration and prolonged ischemia
  • Recovers in 1 week
• Compartment syndrome
• Rabdomyolysis
• Pulmonary emboli

Others

• Esmarch: can bused high in the thigh
• Martin sheet rubber bandage for foot
• Glove finger
• Sterile disposable T

Physiological changes

• Hypoxia, acidosis and cellular cooling
• T induce hypertension
• T pain
• Re perfusion injury after deflation - The re-establishment of blood flow following deflation of tourniquet can - induce a paradoxical extension of ischemic damage mediated by oxygen - free radicals and is known as the “reperfusion syndrome.” This has local - and widespread systemic effects. Acute Respiratory Distress Syndrome - (ARDS), renal and cardiac injuries may occur and may lead to other severe - and often fatal complications.