Pathophysiology and Risks of Pneumatic Tourniquet Use

Question 1

Nursing assessment for Pneumatic Tourniquet

Answer 1

Screen for DVT

Impaired circulation or peripheral vascular compromise

Previous revascularization of extremity

Dialysis access

Metabolic acidosis

Sickle cell anemia

Infection

Tumor

Antihypertensive medications (creatine)

Hx of pain/weakness

Open fx

Increased ICP

Question 2

Determining pressure settings

Answer 2

Wide contoured cuff

Limb Occlusion Pressure (LOP/Systolic BP) + safety margin

Add 40-50mmHg for LOP less than 130mmHg

Add 60-75 mmHg for LOP between 131-190 mmHg

Add 80-100 mmHg for LOP between 131-190 mmHg

Pediatric patients
- Add 50 mmHg to the LOP

Question 3

General guidelines for tourniquet inflation times

Answer 3

60 minutes for upper extremity

90 minutes for a lower extremity for adults

75 minutes for lower extremities for peds patients

Question 4

Patients may experience the following after release of tourniquet

Answer 4

Low BP (Bc of blood being shunted to reperfuse the tissue)
- May also be related to bleeding at the surgical site and reactive vasodilatation

Decrease in core body temperature (use forced air warming)

Question 5

Transfer of care report/post op documentation

Answer 5

Pressure settings

Duration of inflation

Patient outcomes (skin condition, pedal pulses, pain)

Question 6

Documentation for tourniquet

Answer 6

Cuff pressure when inflated

Serial number

Skin protection used

Location where cuff was placed

Skin integrity under cuff before and after removal of application

Name of person who placed cuff

Times of inflation/deflation

Assessment/Evaluation of entire extremity

Any systemic reactions related to ischemia/reperfusion