/policies/,/policies/clinical/,/policies/clinical/uwhc-clinical/,/policies/clinical/uwhc-clinical/department-specific/,/policies/clinical/uwhc-clinical/department-specific/surgical-services/,/policies/clinical/uwhc-clinical/department-specific/surgical-services/equipment-and-supplies/,

/policies/clinical/uwhc-clinical/department-specific/surgical-services/equipment-and-supplies/409.policy

20170382

page

100

UWHC,

Policies,Clinical,UWHC Clinical,Department Specific,Surgical Services,Equipment and Supplies

Pneumatic Tourniquet, Use of (4.09)

Pneumatic Tourniquet, Use of (4.09) - Policies, Clinical, UWHC Clinical, Department Specific, Surgical Services, Equipment and Supplies

4.09

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

February 1996
ORIGINAL
 REVISION

FEBRUARY 2017
PAGE 1
OF 3
POLICY #

4.09
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services

TITLE
PNEUMATIC TOURNIQUET, USE OF IN ALL
PERIOPERATIVE AREAS



I. PURPOSE

To ensure safety by proper use, accurate calibration, proper maintenance, and awareness of potential
complications associated with the use of pneumatic tourniquet.

II. INDICATIONS

A. Maintenance of hemostasis
B. Regional anesthesia
C. Minimize blood loss during burn excision
D. Maintenance of a clear operative field during upper and lower extremity surgery.

III. EQUIPMENT

A. Tourniquet - sterile disposable and clean reusable available for use
1. 42” generally used for larger thighs
2. 34" generally used for adult thigh
3. 24" generally used for large adult arm
4. 18" generally used for adult or adolescent
5. 12" generally used for pediatric patient
6. 8” generally used for pediatric patient
7. Double tourniquet for Bier Block or regional local procedures
B. Webril padding or tourniquet limb protection sleeve
C. Steri-towel drape (waterproof drape)
D. Electric regulator mounted on:
1. IV pole plugged in to A/C

IV. RELATIVE CONTRAINDICATIONS

The final decision whether to use a tourniquet rests with the attending physician.

A. Patient with known vascular insufficiency secondary to atherosclerosis, diabetes, etc.
B. Patient with sickle cell disease may produce sickle crisis in ischemic extremity.
C. Infection present in the extremity may systematically spread by forceful exsanguination.
D. Severe hypertension.
E. Severe crushing injury.


UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

February 1996
ORIGINAL
 REVISION

FEBRUARY 2017
PAGE 2
OF 3
POLICY #

4.09
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services

TITLE
PNEUMATIC TOURNIQUET, USE OF IN ALL
PERIOPERATIVE AREAS



V. PARTS OF PROCEDURE

A. Preoperative Phase
B. Intraoperative Phase
C. Postoperative Phase

VI. PROCEDURE

A. PREOPERATIVE PHASE
1. Determine need for tourniquet as ordered by the physician. Procedure is performed in the Pain
Clinic, Department of Surgical Services (Inpatient and Outpatient OR), and American Family
Children's Hospital.
2. Electric tourniquet regulators are self-checking for accuracy. Should an out of calibration
condition be detected, the unit will display “Amp” “Fail”. Report this to the supervisor/material
coordinator and send in for repairs.
3. Electric regulators have an adjustable automatic time alarm setting, which is usually set at 60 or
120 minutes.
4. Set pressure on regulator as ordered by the physician. Amount of tourniquet pressure related to:
a. Age - Younger patients require less pressure.
b. Weight - Thinner patients require less pressure.
c. Blood pressure - For effectiveness, a tourniquet pressure about 100 mm HG over systolic
pressure is necessary. Most surgeons will use 250 mmHG for the arm and 250-325
mmHG for the leg.
B. INTRAOPERATIVE PHASE
1. Assess tourniquet site on patient for: Size (weight) and condition of skin; document any
abnormalities.
2. Select appropriate sized cuff and check cuff and cords for tears or missing parts.
a. Cuff sizes:
i. leg = 34 or 42 inches
ii. arm = 18 or 24 inches
iii. Children = 8, 12, or 18 inches
3. Wrap several layers of soft Webril around tourniquet site or use tourniquet protection sleeve.
Protect surface area from tissue damage. Not needed if being placed over already burned tissue.
4. Place and secure cuff ties to the extremity and cords coming off top of cuff. A wrinkle of the
cuff may pinch or blister the skin.
5. Protect skin and cuff from prep solution by wrapping an impervious drape around the cuff.
Prep solution can cause chemical burns when allowed to pool under the tourniquet cuff. Only
needed when cuff is within sterile field.

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

February 1996
ORIGINAL
 REVISION

FEBRUARY 2017
PAGE 3
OF 3
POLICY #

4.09
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services

TITLE
PNEUMATIC TOURNIQUET, USE OF IN ALL
PERIOPERATIVE AREAS



6. Connect cuff cord to regulator cord. Keep connective cords off the floor and localized.
7. Recheck gauge or setting for accuracy.
8. Turn regulator on or inflate at the physician's request.
9. Document inflation time and pressure reading in EMR.
10. Monitor length of inflation time. When inflation time reaches 2 hours, document that physician
is verbally notified of tourniquet time every 5 minutes until tourniquet is deflated. Document
deflation time and re-inflation time if applicable.
a. The usual maximum inflation is 2 hours. The surgeon may then elect to deflate tourniquet
for 20 minutes, then re-inflate (there should be a 5 minute break for every 30 minutes of
inflation time).
b. Accurate monitoring of tourniquet time prevents possible complications caused by
prolonged ischemia or local compression.
11. Check gauge for accuracy and condition of cords during procedure. If tubing becomes kinked, a
false pressure reading may result or disconnection will depressurize the cuff.
12. Record time of deflation.
C. POSTOPERATIVE PHASE
1. After removal of cuff and Webril or sleeve, check and record any changes in:
a. Skin condition
b. Color of extremity
c. Circulation
2. Turn electric regulator off if not in use.
3. Follow up checks of color, motion, sensibility (CMS) should be made of extremities.
Frequency is determined by type of procedure done.
4. Any complication occurring during use of tourniquet needs to be assessed, documented, and
patient safety net followed up.
5. Leave electric tourniquet regulator plugged in to recharge battery.

REVIEWED BY
Timothy King, MD 7/2016
Gerald Lang, MD 7/2016
Surgical Services Policy & Procedure Committee 2/2017

SIGNED BY
Anne Mork, MHCDS, MS, RN
Interim Director, Surgical Services Department