AST Guidelines for Best Practices for Safe Use of Pneumatic Tourniquets

8 the increase in cerebral blood flow during deflation. 33,37,38 6. Body temperature is affected by the use of a tourniquet starting with exsanguination through deflation and cooling in the occluded limb due to ischema. 10 The core body temperature increases after tourniquet application due to the decrease in surface area for heat to escape causing less heat to transfer from the core to the periphery of the body. Upon cuff deflation, the core body temperature decreases as the body heat is allowed to escape to the periphery and hypothermic blood from the extremity enters the systemic circulation. The anesthesia provider maintains the core body normothermia during surgery to control the decrease in temperature. 39,40 7. As previously stated, tourniquet pain is the most commonly reported tourniquet complication; pain is reported to develop in up to 66% of patients approximately 30 – 60 minutes after cuff inflation. 10 Patients report a dull, aching sensation at the site of the tourniquet. 11,41,42 The pain occurs more often with the use of general anesthesia as well as occurs most often during lower extremity surgery. 11 The pathophysiology is not completely understood, but it is thought to be caused by a combination of factors including a cutaneous neural mechanism as well as release of prostaglandins. 43 Many techniques as well as IV drugs including intra-articular injection of local anesthetics have been studied to attempt to decrease the incidence and/or severity of pain, but the only real method that works is cuff deflation. 44,45 8. Due to cuff inflation the extremity will obviously be insulated from receiving other systemic drugs and therefore, timing the administration of parenteral prophylactic antibiotics is a critical consideration of the surgeon and anesthesia provider to prevent postoperative infection. It’s obviously important that the antibiotic be completely infused and absorbed by the systemic circulation to be effective. 9,46 Clinical studies have suggested that prophylactic antibiotics be administered 5 – 20 minutes prior to cuff inflation to allow for thorough tissue penetration and entry into the systemic circulation. 9.46-48 However, it has also been reported that antibiotic administration ten minutes prior to cuff deflation may be just as effective. 49 Guideline III The CST should know the surgeon’s and anesthesia provider’s overall patient plan for the use of a tourniquet including where the tourniquet will be positioned, size and type of tourniquet, pressure setting, assessment of the patient’s skin condition and contraindications for use of a tourniquet. Additionally, the CST should contribute toward patient safety by inspecting and testing the tourniquet prior to patient use. 1. The CST should know how to set-up the tourniquet system for testing and patient use. The manufacturer’s IFU should always be followed for testing and patient use, and the IFUs should be available in the operating room (OR) while the tourniquet system is being used on a patient. A. Some tourniquet systems can be mounted on IV poles while others are table top units or mounted on portable stands. The CST should know how to place the tourniquet system on the IV pole or portable stand.