AST Guidelines for Best Practices for Safe Use of Pneumatic Tourniquets

9 2. Non-disposable tourniquets should be inspected and tested prior to patient use. 10,50 Tourniquet systems may have automatic cuff testing capability imbedded in the system that allows quick, but thorough testing of the cuff prior to use and after disinfecting. 51 Additionally, the tourniquet system may have an automatic cuff leak detection embedded in the system that can detect leaks in the cuff, connectors and tubing, thus assisting the CST during testing as well as alerting the surgical team during a procedure. 51 If any of the following damages exist the cuff is considered no longer usable and should be disposed of in the correct waste container. A. The cuff and tubing should be checked to confirm they are clean and no cracks, holes or rips are present. 50,52 Additionally, the stiff structure inside the cuff should be palpated through the outer cuff material to determine if permanent kinks or ridges have formed, particularly on the inner surface that will directly contact the patient. 53 B. All tourniquet connectors should have locking connectors that secure the cuff tubing to prevent inadvertent detachment and should be inspected to confirm they are not loose. 6.50 The connectors should be inspected to confirm they are not bent, broken or worn, and the black O-ring on each connector is not cracked, damaged or missing. 53 Units with Luer-lock connectors must be removed from service to prevent accidental connections to the patient’s IV tubing and infusion pump administration sets to avoid the patient from acquiring an air embolism. 6.54 C. If there are tie ribbons they should be inspected for fraying or tears. 53 Tie ribbons are used to stabilize the position of the cuff by providing a secure cuff application and prevent the cuff from moving during the surgical procedure. Cuffs are available with releasable application handles that should be inspected for tears, fraying and proper operation. Releasable application handles provide an improved cuff application, faster cuff removal and are an improvement over tie ribbons in maintaining the position of the cuff during the surgical procedure. 55 D. The Velcro material (hook and loop) should be inspected for tears or if the stitching is broken or frayed. 53 Additionally, the Velcro should be inspected to ensure that fibers from the cleaning cloth that cannot be removed are not imbedded in more than 25% of the contact closure that could prevent adequate closure of the cuff. 53 E. If the system uses a battery for power, the battery should be checked to confirm it has adequate power for the duration of the procedure; a self-test should be performed. 6 Additionally, the tourniquet system should have a back-up battery that ensures normal function in the event the health care facility experiences a power-supply outage. 25 If a tank is used to provide pressure to inflate the cuff the gas level should be checked prior to the patient entering the OR; additionally, the hose that attaches the cuff to the tank should be inspected to make sure the connectors are not damaged and the hose is long enough. 53,54