Survey of tourniquet use in podiatric surgery

Foot & ankle international, 2005

Tourniquet technique varies among foot and ankle surgeons, and to establish a standard practice guideline the current standard of care should be examined. One hundred and forty responses were received after 253 surveys were mailed to American Orthopaedic Foot and Ankle Society (AOFAS) members, concerning type of tourniquets, location, and pressures used. Cuff pressures most commonly used were 301 to 350 mmHg for thigh cuffs (49% of thigh cuff users) and 201 to 250 mmHG for calf and ankle cuffs (52% of calf cuff users, 66% of ankle cuff users). A substantial number of foot and ankle surgeons who use calf and ankle cuffs frequently use pressures above 250 mmHg (41% of calf cuff users, 19% of ankle cuff users). Only 9% use limb occlusion pressure when determining cuff pressure. Based on the existing evidence-based literature these pressures may be higher than necessary for many patients, and increased adoption of optimal pressure setting techniques as reported in the literature may hel...

Indian Journal of Orthopaedics, 2012

Tourniquets are commonly used in limb surgeries, be it orthopedic or plastic surgeries. But the inflation pressures, the duration, and release guidelines are still not clear. According to a survey, majority of orthopedic surgeons inflate the tourniquet to fixed pressures for the upper and the lower limbs without considering the baseline blood pressure of the patient on whom the tourniquets are being applied. This review was designed to recall and review the safe use of tourniquets and the various techniques that can be employed to minimize the complications of tourniquet use. Google, science direct, and pubmed were searched for appropriate literature and relevant articles were identified.

Specific objective: A study was undertaken to evaluate the superiority of Lowest occlusion pressure method of using the pneumatic tourniquet verus the other routine ways of usage of Pneumatic Tourniquets in Orthopaedics surgery which include the Fixed and Systolic Blood Pressure variants. Materials and methods: This study included 120 patients of both upper and lower limbs trauma. These patients were randomly included any of the three categories of study after fullfilling the inclusion and exclusion criteria. Three modalities of application of toruniquet were included in this study. They were Fixed, Systolic Blood pressure (SBP) and Lowest Occlusion Pressure methods (LOP). Each category included 40 patients and the results were analysed according to final outcome using Ishii et al. grading, VAS Score criteria. Results: In our study 120 cases managed by LOP had better results compared to fixed variant and Systolic BP variant in terms of less pressure needed to keep tourniquet, good operative field, pain score (VAS) at tourniquet application region and skin injury (reddening). But no complications like compartment syndrome, deep vein disorder, paresis, nerve injury has occurred before and after surgery Conclusion: LOP method of using the pneuamtic tourniquet is superior to the other methods of using Tourniquet in terms of less pressure needed for elevating tourniquet, Good operative (blood less) field, no skin abrasions. Introduction The use of pneumatic tourniquet in orthopaedic surgery has been widely debated over the years. A pneumatic tourniquet is a device that allows the surgeon to have a bloodless field for the duration of the surgery [1, 2]. This allows the surgeon to reduce the surgical time since all the anatomic structures are clearly visualised. The reason for debate is due to the post-operative problems experienced by the patient. Tourniquet site pain, tourniquet palsy, chemical burns at the site of tourniquet are common patient related problems consequent to using a tourniquet [3-5]. Great efforts have been made to identify the minimum pressure to which the tourniquet should be inflated so as to avoid the above mentioned problems. [6] In this study, we aim to use the pneumatic tourniquet by inflating it to the lowest occlusion pressure (LOP) and study its effects in terms of quality of bloodless field and post-operative complications. The results were compared with the standard techniques of using a tourniquet described already in the literature.

Iranian Red Crescent medical journal, 2015

A tourniquet is a device that is used frequently in most orthopaedic surgeries but this routine device can lead to serious complications so we decided to review and declare it for safe instruction and use. We searched the word "tourniquet" in PubMed and Google and reviewed all full text English articles and abstracts of non-English articles. In addition, we read all the reference pages of articles to find the new references. The use of tourniquet in orthopedic surgery can lead to serious but rare complications that can be prevented by its correct knowledge and use. At present, there is not enough evidence to discontinue the routine uses of tourniquets.

Acta orthopaedica et traumatologica turcica, 2014

The aim of this study was to investigate and interpret the trends in tourniquet use and the accuracy of knowledge among Turkish orthopedic physicians through face-to-face survey. Turkish orthopedic physicians actively practicing operative orthopedics were questioned in a 12 question face-to-face survey. Personal information of physicians, preferred cuff pressure (CP) and tourniquet inflation time (TIT) and the source of the information for these preferences were questioned. Answers gathered were analyzed statistically. The survey was completed by 211 orthopedic physicians. Mean preferred CP and TIT was 247.1 mmHg and 108.6 minutes, respectively, in the upper limb (UL) and 345.02 mmHg and 122.4 minutes, respectively, in the lower limb (LL). A statistically significant correlation was found between the amount of pressure preferred in the LL and the years of practice; longer the years in practice, higher the amount of pressure preferred (r=0.144, p=0.04). Tourniquets were used for a ma...

IP Innovative Publication Pvt .Ltd, 2017

Introduction: This study was undertaken to evaluate LOP (lowest occlusion pressure) is superior to the other ways of usage of Pneumatic Tourniquets in Orthopaedics surgery i.e. Fixed and Systolic BP variant. Materials and Method: 120 cases of both upper and lower limbs operated from period September 2013 to October 2015 are randomly included in the study after full filling the inclusion and exclusion criteria and managed using Fixed, Systolic BP and LOP, each of the groups included 40 cases and results were analysed according to final outcome using Ishii et al. grading, VAS Score criteria. Results: In our study 120 cases managed by LOP has a better result when compared to fixed variant and Systolic BP variant in terms of less pressure needed to keep tourniquet, good operative field, pain score (VAS) at tourniquet application region and skin injury(reddening). Bloodless field was excellent in 33 patients {[14 (35%) in LOP, 9(22.5%) in Systemic and 10 (25%) in Fixed Tourniquet variant. Among 120 patients, 11 (27.5%), 35 (87.5%) and 40 (100%) patients had experienced Skin abrasions/ Flaring were observed in the patient who underwent LOP, systemic and Fixed Tourniquet respectively. But no complications like compartment syndrome, deep vein disorder, paresis, nerve injury has occurred before and after surgery. Conclusion: LOP is superior to all other ways of Tourniquet in terms of less pressure needed for elevating tourniquet, Good operative (bloodless) field, no skin abrasions.

The Journal of Bone and Joint Surgery (American), 2009

International Journal of Research in Orthopaedics

Background: A pneumatic tourniquet is a constricting or compressing device with an inflatable cuff used to control venous or arterial circulation to an extremity for a period of time. Tourniquet safety is related to the cuff pressure and duration of application. The objective of this study was to determine the common complications that follow the use of pneumatic tourniquet in elective orthopaedic surgical procedures at National Orthopaedic Hospital Enugu.Methods: This was a prospective study over 18 month period (June 2014 – November 2015) at National Orthopaedic Hospital, Enugu. Following ethical approval and written informed consent, patients who met the inclusion criteria were consecutively recruited. The study was conducted using the ‘intelligent pneumatic tourniquet’ with single bladder reusable cylindrical cuff. The cuff pressure was determined in each case by addition of 100mmHg to the baseline systolic BP for the upper limbs and 150 mmHg to the baseline systolic BP for the ...

2004

In groundbased tactical situations and prehospital settings, the tourniquet is used as a life-saving hemorrhage control device. It must completely stop blood flow, must be fast and simple to self-apply, and must require minimal training. However, an improperly designed or used tourniquet can cause loss of the limb, compromised limb salvage, and systemic effects harmful to the patient; all may result from excess tourniquet pressure, excess tourniquet time, or a tourniquet that is too narrow. Most existing prehospital tourniquets use technology from the 1800's: mechanically tightened narrow bands that apply uncontrolled pressures (e.g. Spanish Windlass). In contrast, the modern pneumatic tourniquet is considered indispensable in common surgical procedures, and is now used thousands of times each day to completely occlude arterial blood flow in limbs continuously throughout surgeries lasting several minutes to several hours, and longer using appropriate techniques. Injury or compromise of limb recovery due to pneumatic tourniquet use in surgery is rare. The purpose of this study was to test a newly developed prehospital pneumatic tourniquet, which is based on proven surgical tourniquet designs. The new device has an inflatable bladder, a manual inflator, and a locking clamp. It weighs 220 g, packs to 570 cm 3 , and fits arms and thighs up to 85 cm circumference. To demonstrate effectiveness at safe pressures, the new tourniquet was applied to adult volunteers. Arterial occlusion (indicated by Doppler stethoscope) was reached at an average pressure of 229 mmHg (SD 32, range 165-302, n = 32) on the thigh and 140 mmHg (SD 17, range 106-175, n = 32) on the upper arm. The tourniquet was then used on thighs in 21 surgical procedures at the normally used pressures of 300-350 mmHg. Good hemostasis was maintained in all cases and there were no complications. Users found the tourniquet very easy to apply after a single demonstration. To demonstrate single-handed self-application after minimal training, volunteers were given one demonstration and then timed during self-application to the upper arm and thigh using their non-dominant hand only. First-time application and inflation averaged 29 seconds for the arm (range 22-40, SD 6.8, n = 7 volunteers) and 36 seconds for the thigh (range 24-62, SD 12.5, n = 7 volunteers). After 5 minutes of additional demonstration and practice, average times improved to 23 s (arm, SD 8.3, p = 0.035, n = 16 volunteers) and 26 s (thigh, SD 5.2, p = 0.042, n = 16). To demonstrate effectiveness when access over the distal end of the limb is impossible, volunteers unthreaded the tourniquet, passed it around the limb, and inflated to occlusion. Average times were 43 seconds (arm, SD 10.7, n = 16) and 43 seconds (thigh, SD 13.4, n = 16). The new prehospital pneumatic tourniquet studied proved safe, effective, and reliable in volunteer testing and in clinical evaluations. In contrast to most existing prehospital tourniquets, the new device occludes blood flow at safe pressures over adequate width, as has been proven safe in routine limb surgery. Manual and electronic controllers for the new prehospital pneumatic tourniquet are also described and discussed.

2014

Pneumatic tourniquets are used many thousands of times per day in orthopaedic and non-orthopaedic surgical procedures throughout the world, facilitating operations by reliably establishing a bloodless surgical field with a high level of safety. Within the last thirty years, there have been important improvements in the technology of tourniquet instruments and tourniquet cuffs, leading to greater safety and efficacy in surgical procedures and non-surgical settings. This paper provides an overview of current concepts in tourniquets in the following six areas: 1) Safety features integrated into modern tourniquet systems; 2) The use of Limb Occlusion Pressure (LOP) to enable individualized, optimal tourniquet pressure settings to be achieved; 3) Personalization of tourniquet cuffs through the use of variable contour design and availability of cuffs to fit pediatric and bariatric patient populations; 4) Reduction of soft tissue injuries through the use of limb protection sleeves matched ...