Tourniquet in Orthopedics

Flashcards about Tourniquets in Orthopedics

Tourniquet

Operations on the extremities are made easier by providing good control over blood spillage into the surgical wound.

Pneumatic tourniquet

Automatic continuous pressure controlled and regulated or Hand pump with pressure gauge.

Safest Tourniquet

A pneumatic tourniquet with a hand pump and an accurate pressure gauge.

Size of cuff recommended for healthy limb

Arm–10 cm; leg–15 cm or wider in large legs.

Recommended sites for tourniquet application

Upper arm and mid/upper thigh.

Inflation pressure for tourniquet

50–100 mm Hg above systolic for the arm; double systolic for the thigh; or arm 200–250 mm Hg, leg 250–350 mm Hg

Maximum allowed Time for tourniquet use

Absolute maximum 3 hours (recovers in 5–7 days) generally not to exceed 2 hours.

High risk patients at exsanguination

Morbidly obese patients, Prolonged immobilization prior to surgery, Patients with deep vein thrombosis (DVT), Isolated limb malignancies and infections and Patients with left ventricular dysfunction

Tourniquet application requirements

The tourniquet should encircle the limb and needs to be 7–15 cm more than the circumference of the limb at the point of application

Krackow maneuver

Assistant manually grasps the flesh of the extremity just distal to the level of tourniquet application and firmly pulls this loose tissue distally, while the padding and tourniquet are applied.

Tourniquet pressures for maintaining hemostasis

135–255 mm Hg for the upper extremity and 175–305 mm Hg for the lower extremity

Risked structures from Cuff inflation

The nerves are the structures most at risk apart from vessels and muscles.

Tissue recovery after tourniquet deflation

It takes 40 minutes for the tissues to return to normal physiology after prolonged use of a tourniquet.

Tourniquet complications

Pulmonary embolism, Chemical burn, Superficial slough/abrasion of the skin, Tourniquet paralysis, Post-tourniquet syndrome, Compartment syndrome, Rhabdomyolysis and Vascular complications.

Hematological System Changes due to tourniquet usage

Hypercoagulation state and Hypocoagulation.

Nerve effects of tourniquet usage

Reversible physiological conduction block in motor and sensory nerves seen after 15–45 minutes of tourniquet inflation.

Tourniquet Pain

Vague, dull aching pain in the affected limb is experienced in the arms on tourniquet inflation associated with an increased blood pressure.