2 6 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E A U G U S T 2 0 1 7
and tourniquet design, according to "Safe Tourniquet Use: A Review of the
Evidence," in the Journal of the American Academy of Orthopaedic Surgeons
(osmag.net/DU5gBj).
Q. Should I inspect the tourniquet system before every case?
A. Yes, inspect the system before use to make sure it's complete, clean and func-
tioning, says AORN. Inspection should include verifying that the tourniquet reg-
ulator is compatible with all associated components. Check the regulator for
integrity — that it's functioning within the parameters set by the manufacturer.
Inspect the cuff, tubing, connectors and o-rings for cracks, leaks and other dam-
age. Verify the integrity of the hook and loop fasteners and tie ribbons. Confirm
that there is a full battery power charge.
Q. What are safe pressure settings?
A. Here are suggestions from "Safe Tourniquet Use: A Review of the
Evidence." A tourniquet pressure of 200 mmHg in the upper extremity and 250
mmHg in the lower extremity produces a bloodless field in normotensive per-
sons of average build. This difference is presumably a function of limb girth,
with occlusion occurring at a lower pressure in the upper limb. For anticipat-
ed inflation time of less than 2.5 hours, upper extremity pressure should be
less than 250 mmHg and lower extremity pressure should be less than 300
mmHg. For procedures that will involve prolonged tourniquet times of more
than 2.5 hours, you should measure limb occlusion pressure and use a safety
margin of 50 mmHg to 75 mmHg.
Q. What advantages do personalized tourniquet systems offer?
A. Newer tourniquet systems automatically measure the minimum pressure
required to occlude the limb, and recommend a cuff pressure to be used dur-
ing surgery that is personalized for each patient. By delivering more efficient
application of cuff pressure to the limb, they let you dial in the lowest limb
occlusion pressure needed to occlude blood flow.
