Page 42
B L O O D L E S S
F I E L D S
BEST PRACTICES
AORN Updates Tourniquet Guidelines
ON TIME
Administer antibiotics 20 minutes before inflating the
tourniquet, says AORN.
On June 15, AORN published a major update
of its recommended practices on pneumatic tourniquet-assisted procedures. Here are 4 key areas addressed:
1. Preconditioning. Several studies suggest that preconditioning, either through anesthesia or via a series of cycles of brief inflation and deflation of the tourniquet cuff, can prepare skeletal muscles for ischemia and reperfusion and thereby decrease inflammatory responses.
2. Timing of antibiotics. Recent studies, though inconclusive, suggest that the ideal flow of antibiotics into the blood supply going back to the limb can be achieved by administering antibiotics at the time of deflation. Previously, the recommended practice was to infuse antibiotics 20 minutes before inflating the tourniquet.
3. Nurse's role. The new guidelines encourage nurses to collaborate with the surgeon
(continued next page)
-------------
the limb distal to the cuff, at a specific time, with a specific cuff. Some advanced tourniquet systems measure LOP automatically, but it can also be measured manually by detecting the presence of arterial pulsations in the limb, which indicate arterial blood flow past the cuff into the distal limb.
Current guidelines for setting tourniquet pressure based on LOP call for an additional safety margin of pressure to account for physiologic variations and other changes that occur normally during surgical procedures. (For more on LOP, go to tourniquets.org/lop.php)
2. Use personalized cuffs
Research has also led to the creation of personalized cuffs, which are safer and more effective than traditional straight cuffs because they match patient limb size and
