AST Guidelines for Best Practices for Safe Use of Pneumatic Tourniquets

2 incidences due to pneumatic tourniquet use. 6 The data showed that 41% of the incidences involved bruising and swelling of the tissues and 19% involved blistering or tears of the skin. 6 There are many other reported complications; systemic complications are further addressed in Guideline II, while injuries such as to the skin and nerves are addressed in conjunction with patient safety aspects in Guideline III: • Nerve injuries; 4,5,7 • Pulmonary embolism; • Injuries to the blood vessels; • Injuries to the skin and underlying tissues; • Temperature changes, particularly pediatric patients; 3,8 • Postoperative swelling of tissues and compartment syndrome; 9,10 • Cardiovascular, hematological and respiratory systemic effects when the pneumatic cuff is deflated and metabolic wastes that built up due to ischemia are released into the circulatory system. 10,11 The Guidelines, as stated in the introduction, are meant to provide general information and recommendations that focus on patient safety to avoid complications. The duties of the CST are those described in the role of assistant circulator; henceforth, it will only be indicated if a duty is in the first scrub role. Additionally, there are tasks that are exclusively the responsibility of the surgeon and/or anesthesia provider to perform that will be indicated in the guidelines. Due to the degree of information regarding the various types of pneumatic tourniquet systems that are available on the market, surgery personnel are strongly recommended to be familiar with the manufacturer’s instructions for use (IFU) for each system the surgery department uses. Only pneumatic tourniquets are discussed in this document; it is beyond the scope of this document to include discussion of the use of non-pneumatic tourniquets, e.g., Esmarch bandage, Penrose drain, rubber bands. The components of the pneumatic tourniquet consist of the: • Connective tubing: Connects the cuff to the pressure device • Inflatable cuff: Consists of a rubber bladder that is within a plastic or fabric covering. Cuffs may be a single cuff that contains a single chamber for the air or a double cuff that contains two chambers. • Pressure device: Consists of the air compressor, buttons for setting the pressure, digital display of the pressure setting and timer. The pressure device is run by electricity; therefore, the unit is plugged into a wall outlet. Some units contain a battery that can run the device for a short period of time during power outages. Evidence-based Research and Key Terms The research of articles, letters, nonrandomized trials, and randomized prospective studies is conducted using the Cochrane Database of Systematic Reviews and MEDLINE®, the U.S. National Library of Medicine® database of indexed citations and abstracts to medical and healthcare journal articles. The key terms used for the research of the Guidelines include: Bier block; compartment syndrome; exsanguination; intravenous regional anesthesia; knee arthroscopy; limb occlusion pressure; pneumatic tourniquet; total knee arthroplasty or replacement; tourniquet. Key terms used in the Guidelines are italicized and included in the glossary.