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A common use of air powered equipment is the pneumatic tourniquet. It is used for most procedures of the extremities to create a bloodless field. The pressure is created in a similar way to a blood pressure cuff. The tourniquet is attached to a compressed air cylinder. The pressure can be adjusted by altering the gauge. Pressure set on the gauge is dependent on which limb the tourniquet is applied.
Application
The tourniquet should be applied on the correct operative limb, which should be checked and verbally confirmed. The position of the cuff will not intrude into the operating site. A cotton wool roll (webril) should be applied to the skin to prevent skin damage such as pinching or bruising when the cuff is inflated. This tourniquet pressure and position should be confirmed with the surgeon prior to prepping and inflation.
To ensure the venous blood is drained the limb may be elevated and/or a sterile rubber bandage (esmarch) wrapped around the limb from the distal (far) to proximal (close) end. The tourniquet may then be inflated.
Recommended pressure settings for an arm would be between 200-250 mm Hg and for legs between 300-350mm Hg. When the gauge reached the required setting the rubber bandage may be removed. The setting should always be checked with the surgeon.
The limb will need to be held whilst prepping with antiseptic solution. The surgeon and scrubbed personnel will then apply a sterile drape.
Safety
The compression created by a tourniquet may cause serious nerve/vascular damage if used incorrectly. Interventions whilst using the tourniquet should include;
1. Testing and checking equipment prior to use. Ensuring the bladder cuff, connectors, tubing, gauges are checked for cracks, leaks, and accuracy. Once the pressure has been inflated the tourniquet should be monitored intermittently to ensure the pressure is being maintained. If any faults are noted they should be reported and any faulty equipment replaced.
2. The size and age of the patient should dictate the choice of cuff. Medical conditions such as vascular disease may contraindicate the use of a tourniquet. The cuff should be applied to the limb ensuring the patients skin and tissue are protected. The largest circumference of the limb is the optimal cuff position. The cuff position should be documented on the intraoperative record.
3. The time a tourniquet remains on should be documented. Recommended time limits for a tourniquet would vary, a leg approx; 1 % hours (at a pressure of 500mm) and an arm 1 hour (at 300mm)- Should this time be extended, the tourniquet will need to be deflated for approx 10 mins then reinflated.
OPERATING
Once the tourniquet is inflated the cuff should not be readjusted.
At completion of the procedure the tourniquet should be cleaned with a disinfectant. The cylinder and tubing should also be cleaned.
Compressed Air Cylinders Handling Guidelines
The cylinder valve should be opened slowly anti-clockwise.
Attach the appropriate regulator by hand and secure it with a wrench. Ensure turning it anti-clockwise until it stops turns off the regulator.
When opening the cylinder, turn it slowly. The gauge should read 2000-25,000 psi on the right hand gauge signifying the cylinder is full. Be aware of air leaks.
Turn pressure regulator on by turning in a clock-wise direction. Set the patient pressure gauge (left hand gauge) to the desired pressure.
When finished, turn the regulator off, bleed air out of the tubing. The regulator gauge should read 'O'. Turn off the regulator by turning the knob anticlockwise until it stops.
Turn the connector on regulator in a clockwise direction and pull downward to release connector.
If the cylinder pressure is 500 psi or over, return cylinder to storage. If it registers under 500 psi, remove the regulator and replace the cylinder, reapplying the regulator.
Maintenance and careful handling of equipment may extend the duration of its function. Thus ensuring a safer and less costly outcome for the patient and personnel included in its use.