AST Guidelines for Best Practices for Safe Use of Pneumatic Tourniquets

10 F. The tourniquet should be inflated and deflated to test the system and check for leaks. 50 The cuff should be connected to the tourniquet system, wrapped upon itself and inflated and inspected for leaks. There are tourniquet systems available on the market that include the technology to automatically perform a system check to ensure the components are working properly and will alert the user of any possible hazards or damage. 53 G. Inspect the electrical cord for fraying or damage. If damaged, electrical tape must not be used to repair the cord and the tourniquet unit should be replaced and sent to the HDO’s biomedical engineering department for repair. 56,57 H. Tubing should be kept off the floor to protect from damage and prevent surgical personnel from becoming entangled and falling. 6,54 The tubing should also be checked to ensure it is not kinked or occluded. 52 Dual-line cuffs are available that facilitate the detection of kinks or occlusions ion the line. 25 3. Disposable tourniquet cuffs are a sterile item that are indicated for use on a one- time basis and disposed of after use in the contaminated waste. Disposable cuffs are useful when the cuff needs to be positioned near the operative site or for contaminated surgical procedures. 58 A. Reprocessing a disposable cuff could cause safety hazards for the surgical patient since the manufacturer has not designed the cuff for reprocessing and reuse. 1) Cuff materials may deteriorate or be damaged due to exposure to the chemical or physical agents during disinfection and re- sterilization. 53 Exposure of the thermoplastic materials to higher temperatures during re-sterilization can soften materials causing components such as the tubing, connectors and ports to be damaged. A damaged connector could cause the cuff to separate from the tourniquet system, resulting in unanticipated deflation of the cuff, loss of extremity occlusion and loss of the blood-less surgical site. 2) During disinfection and re-sterilization liquids may enter and block the portal openings and inflatable portion of the cuff. If water remains within the cuff it can react with ethylene oxide during re- sterilization forming the semi-solid substance ethylene glycol which can block the portal openings and inflatable portion of the cuff, as well as be dangerous to the patient and surgical personnel since ethylene glycol is toxic. Blockage of a port(s) can affect the pressure regulation within the cuff during patient use. 53 4. Tourniquet systems use air or nitrogen to inflate the cuff bladder. The manufacturer’s IFU should be followed to select the correct gas to be used with the tourniquet system. Oxygen or nitrous oxide must never be used to inflate the cuff bladder since this increases the risk of fire in the OR; if a tourniquet system uses either gas it should be removed from service. 6,50,59