AST Guidelines for Best Practices for Safe Use of Pneumatic Tourniquets

14 occurred in patients with cast padding and seven blisters occurred in the patients with no protection. 70 2) Matching limb protection sleeves are corresponded to the cuff. The sleeves consist of elastic, low-linting soft material that are sized to match the size range of the matching cuff. 55 Some manufacturers color code their matching limb protection sleeves to ensure the correct sleeve is used with the correct cuff. However, the color coding is specific to each manufacturer, so the sleeves and cuffs from different manufacturers should not be mixed. 55 A sleeve that is not specifically matched to the cuff may not provide enough protection to the underlying skin and subcutaneous tissue, may impede the proper performance of the cuff and could interfere with venous blood flow return when the cuff is deflated. 55 Tredwell et al. (2006) conducted a quantitative analysis of forty-four trials applying a pediatric cuff on two healthy child volunteers in which a tourniquet was used. The matching limb- protection sleeve that was specific to the pediatric cuff produced significantly fewer and less severe pinches and wrinkles of the skin as compared to other methods of skin protection. 71 McEwen et al. (2002) conducted a study where fifty-five trials of five different limb protection types were tested on the upper arms and thighs of five adults. The matching sleeves made of two-layers of tubular elastic material matched to specific cuffs produces significantly fewer and less severe pinches and wrinkles of the skin as compared to other types of padding that were tested. 63 3) If a matching limb protection sleeve is not used, a minimum of two layers of wrinkle-free padding should be placed around the extremity as proximal to the surgical skin incision as possible. 9,10 Cotton-cast padding, sheet padding or Webril should not be used due to their shedding loose fibers/lint that can become embedded in the Velcro closures of the tourniquet and reduce the ability to obtain an effective application of the cuff or create the possibility of the cuff becoming loose during the procedure. 6.63 D. When the cuff is applied it should be flat and even since the effectiveness of the cuff can be compromised if it becomes bent, crinkled or folded causing insufficient pressure to be applied that can result in the local anesthetic entering the systemic circulation and blood entering the surgical site as well as injuring the underlying skin. 52 The cuff should overlap at least three inches, but not more than six inches/beyond the Velcro. 6,11,72 If the overlap is more than six inches, this can cause rolling and wrinkling of the soft tissues and increased pressure in the area of the overlap. 11,52 If the overlap is too small the cuff pressure is compromised that can result in unexpected release of the cuff or inadequate compression. 11