AST Guidelines for Best Practices for Safe Use of Pneumatic Tourniquets

12 3) The patient should also be screened for the following contraindicatons: 10,11,58 • Acidosis • Skin grafts • Diabetes mellitus • Reynaud’s disease • Severe hypertension • Severe crushing injuries • Medications and supplements • Increased intracranial pressure • Extremities with dialysis access • Previous revascularization of the extremity • Post-traumatic lengthy hand reconstruction 6. To reduce intra-and post-operative complications, the appropriate size of cuff should be chosen according to the characteristics of the patient, e.g. circumference of limb, shape of limb, preexisting conditions, type of surgical procedure. 11 A. The surgery department should maintain an adequate inventory of cuff sizes; routine sizes are 8, 10, 18, 24, and 34 inches. 6,11 B. The widest cuff possible should be chosen that doesn’t interfere with the surgical site. 10 Wide bladders can occlude the blood flow with the use of a lower cuff pressure, thus reducing the risk of injury to the patient. 63 1) The size of the cuff should be wider than half of the limb’s diameter. 11,64 Preoperative assessment of the patient may include the surgeon and/or anesthesia provider using a nonstretch measuring tape to measure the circumference of the patient’s extremity in order to choose the proper size of cuff. 53 2) Estebe et al. (2000) conducted a study comparing tourniquet pain tolerance using a narrow and wide cuff placed on each arm of the 20 volunteers; one cuff was inflated at 100 mm Hg above systolic blood pressure and the other at the lowest effective occlusive pressure. The authors concluded that a wide-cuff is more effective than a narrow cuff in occluding the blood vessels and that it is less painful when the pressure is less than 100 mm Hg and pressure is based on arterial pulse loss. 9 C. Contour cuffs are recommended for conical or tapered extremities such as encountered in muscular and obese patients to reduce the excessive pressure on one edge of the cuff. 2,9,65 Contour cuffs have been proven to occlude the blood flow at lower pressures than straight cuffs and when combined with LOP, can significantly reduce the cuff pressure needed to achieve vessel occlusion in both adult and pediatric patients. 25,66 Additionally, straight cuffs transmit the pressure unevenly to the thicker portion of the extremity rather than uniformly across the cuff width. 65 Therefore, the use of a wide, contoured tourniquet is recommended to achieve the lowest possible LOP. 25 1) There are two types of contour cuffs: non-variable contour, also referred to as fixed-contour cuff, and variable-contour cuff. Non-