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GENERAL INFORMATION
User Considerations:
•
Careful and complete exsanguination reportedly prolongs pain-free tourniquet time and improves the quality of
Intravenous Regional Anesthesia (Bier Block anesthesia). However, partial exsanguination may be desirable in
certain cases where residual blood flow will aid in visualization and identification of vascular structures.
•
In the presence of infection and painful fractures, after the patient has been in a cast, and in amputations due to
malignant tumors, exsanguination before tourniquet application may be done without the use of an elastic bandage
by elevating the limb for 3 to 5 minutes.
•
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,
which could cause severe injury to the patient or death.
•
Whenever infiltration anesthesia is used, it has been suggested in the medical literature that the tourniquet remain
inflated for a minimum of 20 minutes from the time of the injection to ensure that most of the anesthetic agent has
been absorbed into the limb tissue. For a procedure requiring only a few minutes, too rapid a release of the
anesthetic agent can be prevented by quickly deflating and reinflating the tourniquet several times.
•
Do not allow preoperative skin preparations to flow and collect under the cuff where they may cause chemical
burns.
•
Inflation must be done as rapidly as possible to occlude arteries and veins simultaneously, and to avoid return of
blood into the limb. Quick deflation aids preventing engorgement.
•
Heat generated by surgical lights or powered instruments is not dissipated in limbs under tourniquet control and
tissue may be subject to drying or trauma. Frequent irrigation, special draping and low power surgical lights are
recommended to reduce the risk of thermal damage.
Application and Use:
•
Select the proper cuff size to allow for the overlap recommended by the 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.
•
The tourniquet cuff must be applied in the proper location on the limb. Tourniquet pressure and the time the
tourniquet is inflated on the limb should both be minimized. There is additional potential risk to superficial nerves
in unprotected areas; never apply a tourniquet over an area where major nerves may be directly compressed
against bone (e.g. peroneal nerve near the proximal head of the fibula). Never apply a tourniquet over the joints of
the limb. Do not readjust an already inflated cuff by rotating it because this produces shearing forces which may
damage the underlying tissue.
•
Do not use an elastic bandage for exsanguination in cases where this will cause bacteria, exotoxins, or malignant
cells to spread to the general circulation, or where it could dislodge thromboemboli that may have formed in the
vessels.
•
Observe the cuff during inflation and periodically while inflated to ensure the cuff is not migrating on the patient's
limb.
•
In case of incomplete or improper inflation, the tourniquet cuff must be fully deflated, and the limb exsanguinated
again before cuff reinflation. Reinflation over blood-filled vasculature may lead to intravascular thrombosis.
•
If the tourniquet cuff migrates on the limb during surgery, apply a pressure dressing to the wound and exsanguinate
the limb by elevation. Deflate and reapply the cuff. Reinflate the cuff and observe for migration. If migration
persists, replace the cuff.
•
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
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GENERAL INFORMATION
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