Adverse Effects - Delfi PTS ii Operator And Maintenance Manual

guination before tourniquet application may be done
without the use of an elastic bandage by elevating
the limb for 3 to 5 minutes.
 In case of failure, the tourniquet cuff must be fully
deflated and the limb exsanguinated again before
reinflation. Reinflation over blood‐filled vasculature
may lead to intravascular thrombosis.
 Tourniquet users must be familiar with the inflation /
deflation sequence when using two tourniquet cuffs
and two PTS ii units together for IVRA (Bier Block
anesthesia), so that the wrong tourniquet will not be
released accidentally.
 Test for hemoglobin type and level before using a
tourniquet on patients with sickle‐cell anemia. When
the tourniquet is used for these patients, the limb
should be carefully exsanguinated and the PO2 and
pH should be closely monitored.
 Select the proper cuff size to allow for the overlap
recommended by the cuff manufacturer. Too much
or too little overlap may cause cuff rolling and
telescoping, unexpected release of the cuff from the
limb, inability to maintain a bloodless field at normal
pressures, and/or undesired pressure distribution on
the limb.
 The skin under the tourniquet cuff must be protected
from mechanical injury by smooth, wrinkle‐free
application of the cuff. If the tourniquet cuff is
applied over any material that may shed loose fibers
(such as Webril) the fibers may become embedded in
the contact closures and reduce their effectiveness.
Follow the cuff manufacturer's recommendations for
limb protection material under the cuff. In general, a
limb protection sleeve designed specifically for the
cuff provides the best protection.
 If skin preparations are used preoperatively, they
should not be allowed to flow nor collect under the
cuff where they may cause chemical burns.
 Whenever the tourniquet cuff pressure is released,
the wound should be protected from blood surging
back by applying pressure dressings and, if necessary,
elevating the limb. Transient pain upon tourniquet
pressure release can be lessened by elevation of the
limb. If full color does not return within 3 to 4
minutes after release, the limb should be placed in a
position slightly below body level.
 The deflated cuff and any underlying limb protection
material should be completely removed as soon as
tourniquet pressure is released. After the cuff has
been fully deflated and removed from the patient,
the unit can be set to STANDBY. Even the slightest
impedance of venous return may lead to congestion
and pooling of blood in the operative field.
 Whenever IVRA (Bier Block anesthesia) is used, it is
recommended that the tourniquet remain inflated for
at least 20 minutes from the time of injection.
1.5 ADVERSE EFFECTS
A dull aching pain (tourniquet pain) may develop
throughout the limb following use. Stiffness, weakness,
reactive hyperemia, & skin discolouration may also occur
to some degree in all patients after tourniquet use.
Pathophysiologic changes due to pressure, hypoxia,
hypercarbia, and acidosis of the tissues occur and become
significant after about 1 1/2 hours of tourniquet use.
Symptoms of tourniquet paralysis are motor paralysis and
loss of sense of touch, pressure, and proprioceptive
responses.
Intraoperative bleeding may be caused by:
1. The slight impeding effect exerted by an
unpressurized cuff (and its limb protection material
or padding, if used), which prevents venous return
at the beginning of the operation,
2. Blood remaining in the limb because of insufficient
exsanguination,
3. Inadequate tourniquet pressure, or slow inflation
and deflation, all if which allow arterial blood to
enter while preventing venous return,
4. Blood entering through the nutrient vessels of the
long bones, such as the femur or humerus.
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