AST Guidelines for Best Practices for Safe Use of Pneumatic Tourniquets

1 Approved April 13, 2007 Revised June 1, 2018 Guidelines for Best Practices for Safe Use of Pneumatic Tourniquets Introduction The following Guidelines for Best Practice were researched and authored by the AST Education and Professional Standards Committee, and are AST approved. AST developed the Guidelines to support healthcare delivery organization’s (HDO) reinforce best practices in the use of pneumatic tourniquets as related to the role and duties of the Certified Surgical Technologist (CST®), the credential conferred by the National Board of Surgical Technology and Surgical Assisting. The purpose of the Guidelines is to provide information OR supervisors, risk management, and surgical team members can use in the development and implementation of policies and procedures for the safe use of pneumatic tourniquets in the surgery department. The Guidelines are presented with the understanding that it is the responsibility of the HDO to develop, approve, and establish policies and procedures for the surgery department regarding pneumatic tourniquet practices per HDO protocols. Rationale Pneumatic tourniquets are utilized during extremity surgery to maintain a bloodless field and prevent an anesthetic drug from exiting an extremity during intravenous regional anesthesia (IVRA), e.g. Bier block . A tourniquet applies pressure to the blood vessels to occlude the blood supply to the operative limb. Even though the pneumatic tourniquet has been placed in the lowest risk category for medical devices by the Food and Drug Administration, Class 1 General Controls, the pneumatic tourniquet can cause nerve, vessel and tissues injuries to the patient, temporary or permanent, due to incorrect cuff placement, incorrect size of tourniquet, excessive tourniquet pressure, prolonged inflation and improper protection of the skin underlying the tourniquet. 1,2 The most commonly reported complication associated with the use of pneumatic tourniquets is pain. 3 As far back as 1985, the Arthroscopy Association of North America completed a national survey in which 930 complications were reported in 118,590 arthroscopic procedures. Sixty-three of the complications were neurological injuries, and of those, fifty of the complications were due to the use of a tourniquet. 4 In 2006, Odinsson et al. published the results of its survey of 265 surgeons. The authors stated that eighteen complications were reported that included three cases of blistering and skin necrosis; two cases of permanent lower-limb nerve complications; thirteen nerve complications that resolved within six months of surgery; six cases involving paresis; six cases involving sensory disturbance; and one case involving complete sensory and motor palsy in the arm. 5 The Pennsylvania Patient Safety Authority (PSA) collected data from December 2004 though December 2009 and stated there were 140 reported patient