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Industry: Email Alert RSS FeedRecommended practices for use of the pneumatic tourniquet
AORN Journal, Feb, 2002
The following recommended practices were developed by the AORN Recommended Practices Committee and have been approved by the AORN Board of Directors. They were presented as proposed recommended practices for comments by members and others. They are effective Jan 1, 2002.
These recommended practices are intended as achievable recommendations representing what is believed to be an optimal level of practice. Policies and procedures will reflect variations in practice settings and/or clinical situations that determine the degree to which the recommended practices can be implemented.
AORN recognizes the numerous types of settings in which perioperative nurses practice. These recommended practices are intended as guidelines adaptable to various practice settings. These practice settings include traditional ORs, ambulatory surgery units, physicians' offices, cardiac catheterization suites, endoscopy suites, radiology departments, and all other areas where operative and other invasive procedures may be performed.
Purpose: These recommended practices provide guidelines for use of pneumatic tourniquets, which primarily are used to occlude blood flow and obtain a near bloodless field for extremity surgery. Pneumatic tourniquets also are used to confine a bolus of local anesthetic in an extremity during IV regional anesthesia (IVRA [ie, Bier's block]). These recommended practices provide information for testing, applying, cleaning, and documenting the use of pneumatic tourniquet equipment. Pneumatic tourniquets consist of an inflatable cuff, pressure source, pressure regulator, connective tubing, and pressure display. These recommended practices provide general guidelines for developing policies and procedures for tourniquet use in the practice setting. Due to the variety and complexity of current tourniquet equipment, policies and procedures will reflect considerations for the specific tourniquet system being used.
RECOMMENDED PRACTICE I
Personnel should demonstrate competency in use of pneumatic tourniquets in the practice setting.
1. Perioperative personnel should be instructed in the proper operation of pneumatic tourniquets before use. Instruction and return demonstration of proper use of a pneumatic tourniquet reduces the risk of patient injury and extends the life of the pneumatic tourniquet.
2. Personnel should participate in ongoing competency assessment and educational activities that will facilitate acquisition of knowledge and skills that affect patient outcomes. (1)
RECOMMENDED PRACTICE II
Pneumatic tourniquets should be cleaned, inspected, tested, and maintained before and after use according to manufacturers' written instructions.
1. Preoperatively, the entire tourniquet system should be checked. Before each use, pneumatic tourniquets should be inspected for cleanliness and tested for integrity and function. Most electric tourniquets automatically self-test and calibrate upon activation. The cuff, tubing, connectors, gauges, and pressure source should be clean and kept in working order. The cuff and tubing should be inspected for cracks and leaks. Patient safety demands that all tourniquet parts function properly before a procedure. Connectors should be fastened securely to the tourniquet pressure source to prevent accidental deflation of the cuff during use. Unintentional pressure loss can result from loose tubing connectors, deteriorated tubing, stopcock leaks, cuff bladder leaks, or worn cuff closures. (2)
2. Reusable cuffs and bladders should be cleaned, rinsed, and dried between patient use according to the manufacturers' instructions and AORN's "Recommended practices for high-level disinfection." (3) The cuff and bladder should be rinsed thoroughly because cleaning solution residue may increase the chance of allergic reactions and decrease the life of the cuff and bladder. All tubing should be wiped with an US Environmental Protection Agency (EPA) high- or intermediate-level tuberculocidal disinfectant and dried before storage. Care must be taken to prevent introduction of solutions into the pons. Water in the ports contributes to microbial growth. Subsequent deflation of wet bladders may cause minute droplets of solution to be forced into the tourniquet regulating mechanism, causing damage. (4)
3. If blood or other body fluids come in contact with tourniquet components, more extensive cleaning with an enzymatic solution and an EPA high- or intermediate-level tuberculocidal disinfectant capable of inactivating bloodborne pathogens is necessary.
4. The frequency, method, and criteria for pneumatic tourniquet testing should be established according to manufacturers' written instructions. A pneumatic tourniquet management program assists in identifying equipment problems that may have adverse effects on patient safety. (5)
5. Documentation should reflect the biomedical equipment and/or serial number, date of inspection, preventive maintenance, and status of all equipment. Records of equipment failure and preventive maintenance assist in identifying equipment performance problems or hazards and minimize clinical and physical risks. (6)
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