A tourniquet is a constricting or compressing
device used to control venous and arterial
circulation to an extremity for a period of time.
Pressure is applied circumferentially upon the
skin and underlying tissues of a limb; this
pressure is transferred to the walls of vessels,
causing them to become temporarily occluded. It
is generally used as a tool for a medical
professional in applications such as cannulation
or to stop the flow of traumatic bleeding,
especially by military medics.
The earliest known usage
of a tourniquet dates back
to 199 BC. It was used by
the Romans to control
bleeding, especially during
In 1718, French surgeon
Jean Louis Petit developed
a screw device for
occluding blood flow in
surgical sites. He named
this device after the French
verb tourner (to turn),
“tourniquet” as it is
commonly known today.
Joseph Lister is credited for being the first to use a
tourniquet device to create a bloodless surgical field
In 1873, Friedrich von Esmarch developed a rubber
bandage that would both control bleeding and
exsanguinate. This device is known as Esmarch's
bandage for surgical haemostasis or Eschmarch's
In 1904, Harvey Cushing created a pneumatic
SURGICAL TOURNIQUET EMERGENCY TOURNIQUET
Surgical tourniquets are frequently used in orthopedic
surgery while emergency tourniquets are limited to
emergency situations to control blood loss.
Surgical tourniquets prevent blood flow to a limb and
enable surgeons to work in a bloodless operative field.
This allows surgical procedures to be performed with
improved precision, safety and speed. Tourniquets are
widely used in orthopaedic and plastic surgery, as well as
in intravenous regional anaesthesia (Bier block
anaesthesia) where they serve the additional function of
preventing local anaesthetic in the limb from entering
Emergency tourniquets are used in emergency bleeding
control to prevent severe blood loss from limb trauma.
Emergency tourniquets are generally used as a last resort,
especially in civilian applications, for all blood flow below
the application of an emergency tourniquet is stopped,
and can subsequently kill the tissue, leading to eventual
loss of the limb below application.
Limb occlusion pressure (LOP) is the minimum
tourniquet pressure required to occlude blood flow to
a specific patient's limb at a specific time and
accounts for a patient’s limb and vessel
characteristics, and the type and fit of the cuff. LOP
can be determined by gradually increasing tourniquet
pressure until distal arterial pulses cease, as indicated
by a device sensing blood flow, such as a Doppler
stethoscope. Studies have shown that cuff pressure
based on LOP measured immediately prior to surgery
is generally lower than commonly used cuff pressures
and is sufficient to maintain a satisfactory surgical
The Combat Application
Tourniquet (C-A-T) is
used by the U.S. and
British military to provide
soldiers a small, effective
tourniquet in field combat
situations, and is also in
use by NHS ambulance
services, and some UK fire
and rescue services
Automatic tourniquet systems
are capable of providing safety
features that are not possible in
older mechanical tourniquets.
These systems can monitor the
cuff inflation time as well as
regulate the cuff pressure to a
known pressure throughout the
surgical procedure. Some
tourniquets are capable of
calculating the proper pressure
to ensure complete blood
occlusion in about 30 seconds.
This assists the operating room
staff in deciding what the
tourniquet pressure should be
set at on a per-patient basis.
METHOD OF APPLYING TOURNIQUET
IN AN EMERGENCT SET-UP
Reduction of certain fractures.
Kirschner wire removal.
Replacement or revision of the joints of the knee, wrist,
digits, hand, or elbow.
Arthroscopy of the knee, elbow, wrist, hand, or digits.
Graft and repair of lacerated tendons.
Repair of traumatic nerve damage.
Carpal tunnel release.
Traumatic or non traumatic amputation.
Correction of a hammer toe.
Plastic and Reconstructive Surgery
Repair of burn contractures.
Excision of lesions or tumors of the limbs.
Split - thickness skin grafts on burned patients.
Amputations or replantations.
Repair of bone, cartilage, tendons, nerves, or blood
Resection of invasive tumors or lesions.
Repair of congenital anomalies (e.g., syndactyly or
Bilateral extremity surgery (e.g., foot - to - hand
transfer of digits, related to the amputation).
Intravenous Regional Anesthesia
In intravenous regional anesthesia (IVRA), local
anesthesia and a bloodless operative field are
produced by inflation of a dual - bladder tourniquet
proximal to the operative site, followed by injection of
a local anesthetic agent distal to the tourniquet.
Use in a Non - surgical Setting
The nonsurgical use of pneumatic compression devices is
commonly directed toward manipulation of venous and
arterial circulation for the purpose of reducing primary or
secondary circulatory problems.
External pneumatic calf compression is a preventive
therapy for patients at risk for deep venous thrombosis.
Knee - length inflatable plastic boots with an alternating
pressure cycle are used to prevent sluggish venous blood
Military Anti - Shock Trousers (MAST suits) can be used
for early treatment of hypovolemic shock in trauma
victims. The trouser pressure acts like an inflatable
tourniquet to reverse shock by redirecting blood from the
legs and pelvis into central circulation, thus raising the
blood pressure and increasing perfusion to vital body
The final decision on whether or not to use a
tourniquet rests with the attending physician. A few
possible contraindications that the physician may
take into consideration are:
Open fractures of the leg.
Post - traumatic lengthy hand reconstruction.
Severe crushing injuries.
Elbow surgery (with concomitant excess swelling).
Skin grafts (to help distinguish all bleeding points).
Compromised circulation (e.g., peripheral artery
Post - Tourniquet Syndrome
Post - tourniquet syndrome (PTS) is manifested by
pronounced and, at times, prolonged postoperative
swelling of the extremity. Approximately half of all
post - tourniquet swelling is caused by blood
returning to the limb after the release of the
tourniquet (hyperemia). The remainder is the result
of post ischemic reactive hyperemia, an additional
increase of blood to restore normal acid - base
balance in tissue. Post - tourniquet syndrome is
characterized by edema, stiffness, pallor, weakness
without paralysis, and subjective numbness without
The complication occurs in patients who have had
tourniquets applied for a prolonged time and also in
patients whose tourniquet cuff pressures were
insufficient to prevent arterial inflow while preventing
venous outflow. Under inflation of the tourniquet cuff
is a particular risk for elderly patients who frequently
have extensive calcification of the major arteries,
which renders the vessels noncompliant to tourniquet
pressure. Rheumatoid arthritis patients on steroid
treatment experience the same problem in which a
bloodless field cannot be obtained because of steroid -
induced vascular calcification. Because of the
significance of postoperative bleeding, patients with
prolonged clotting times also are at risk for post -
Medication history. A patient's drug history should
detect the routine ingestion of any drug that will
influence clotting time or promote development of
atherosclerotic vascular disease. Among these are
steroids, aspirin, and birth control substances.
History of hypertension.
History of past thromboembolic occurrences.
Evidence of arterial calcification.
Comply strictly with the recommended tourniquet
time limit. A higher than normal pressure may be
required, particularly in larger limbs, and it is
particularly important with these at - risk patients to
use arterial occlusion pressure (see LOP section
above) rather than systolic blood pressure to
determine the most appropriate tourniquet cuff
pressure and if possible to avoid exceeding the
recommended maximum cuff pressure limits
(typically recommended to be 300 - 350 mmHg for the
thigh and 250 - 300 mmHg for the arm and lower leg).
Hair tourniquet is a medical condition where in a
hair or other thread becomes tied around a toe or
finger tightly, so as to put the digit at risk of damage.
Occasionally this is known as Toe tourniquet.
The problem usually arises in babies and small
children when hairs and thread are lost loosely inside
They can become spontaneously tied round a
toe and will tend to tighten with wriggling. Natural
hair is much more likely to undergo this phenomenon
than spun thread.
The ligature must be cut or dissolved as quickly as
possible. Often it is possible to lift a portion of it to
enable cutting, but in a severe case the ligature must
be cut through the skin. This is, of course, injurious to
the child, but does prevent loss of the digit.
Despite the distressing nature of the condition,
outcomes are excellent. Loss of the toe is extremely
rare, as is any residual disability.