pneumatic tourniquets

1. THE TYPES OF TOURNIQUETS
AND THE GENERAL
PRINCIPLES OF THEIR
APPLICATION
PRESENTATION BY KUNAL SHRIVASTAVA

2. ORIGINS OF THE
WORD:
The word tourniquet is derived from French,meaning ‘to turn’.
Term coined by Jean Louis Petit in 1718.
Joseph Lister first employed it to provide a bloodless field in 1873.
Johann von Esmarch then made a bandage - Flat & woven from
India rubber.
Complication:Associated with nerve palsies.
Harvey Cushing in 1904 -pneumatic Tourniquet, the most basic of
its kind-The primordial modern tourniquet.

3. 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.

4. TYPES:
1)EMERGENCY TOURNIQUET.
2)SURGICAL TOURNIQUET.
Surgical tourniquets are frequently used in orthopedic surgery while emergency
tourniquets are limited to emergency situations to control blood loss.

5. THE EMERGENCY
TOURNIQUET(C.A.T)
The Combat Application Tourniquet (C-A-T) is used by the U.S. and Briti

6. THE SURGICAL
TOURNIQUET
Surgical tourniquets are available for operations around the upper and lower limbs.

7. TYPES OF SURGICAL
TOURNIQUETS
• MANUAL(OPERATION):
• 1)PNEUMATIC.
• 2)ESMARCH.
• 3)MARTIN SHEET RUBBER BANDAGE.
• AUTOMATIC.

8. HOW TO APPLY THE
SURGICAL TOURNIQUET
A tourniquet is a potentially dangerous instrument that must be used with
proper knowledge and care.
The upper arm or the thigh is wrapped with several thicknesses of smoothly
applied cast padding.

9. All air is first withdrawn from the tourniquet before application
A gauze bandage is then wrapped around it to prevent its slipping during action.
The extremity is elevated for 2 minutes, or the blood is expressed by a sterile sheet rubber
bandage or a cotton elastic bandage.
The tourniquet should be inflated quickly to prevent filling of the superficial veins before the
arterial blood flow has been occluded.

10. HOW TO APPLY IN AN
OBESE PATIENT
In obese patients, an assistant manually grasps the flesh of the extremity just
distal to the level of tourniquet application and firmly pulls this loose tissue
distally.
Traction on the soft tissue is maintained while the padding and tourniquet are
applied, and the latter is secured.

11. TOURNIQUET
PRESSURE
The exact pressure to which the tourniquet should be inflated has not been determined.
The correct pressure depends on the age of the patient, the blood pressure, and the size
Tourniquet pressures of 135 to 255 mm Hg for the upper extremity and 175 to 305 mm

12. BRAITHWAIT AND KLENERMAN’S
MODIFICATION OF BRUNER’S TEN
RULES FOR TOURNIQUET
APPLICATION
APPLICATION
Apply only to a healthy limb or with caution to an unhealthy limb
SIZE OF TOURNIQUET Arm, 10 cm; leg, 15 cm or wider in large legs
SITE OF APPLICATION Upper arm; mid/upper thigh ideally
PADDING At least two layers of orthopaedic wool
SKIN PREPARATION
Occlude to prevent soaking of wool. Use 50-100 mm Hg above systolic for the
arm; double systolic for the thigh; or arm 200-250 mm Hg, leg 250-350 mm Hg
(large cuffs are recommended for larger limbs instead of increasing pressure)
TIME Absolute maximum 3 hr (recovers in 5-7 days) generally not to exceed 2 hr
TEMPERATURE Avoid heating (e.g., hot lights), cool if feasible, and keep tissues moist
DOCUMENTATION
Duration and pressure at least weekly calibration and against mercury manometer
or test maintenance gauge; maintenance every 3 months

13. THE AUTOMATIC
TOURNIQUET
Automatic tourniquet systems are capable of providing safety features that are n

15. USES IN
ORTHOPEDICS
Replacement or revision of the joints of the knee,
wrist, digits, hand, or elbow.
Arthroscopy of the knee, elbow, wrist, hand, or digits.
Bone grafts.
Fractures of elbow, forearm, knee and leg.
Hand surgeries.
Graft and repair of lacerated tendons.
Repair of traumatic nerve damage.
Traumatic or non traumatic amputation.
Podiatry.

16. 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 vessels.
Resection of invasive tumors or lesions.

17. ANAESTHESIA
In intravenous regional anesthesia (IVRA), local anesthesia and a bloodle

18. USES OF TOURNIQUET IN
EMERGENCY
The non-surgical use of pneumatic compression devices is commonly directed
External pneumatic calf compression is a preventive therapy for patients at risk
Military Anti-Shock Trousers (MAST suits) can be used for early treatment of

19. COMPLICATIONS:

20. TOURNIQUET
PARALYSIS
Tourniquet paralysis can result from:
(1) excessive pressure
(2) insufficient pressure, resulting in passive congestion
of the part, with hemorrhagic infiltration of the nerve.
(3) keeping the tourniquet on too long.
(4) application without consideration of the local
anatomy.

21. The final decision on whether or not to use a tourniquet rests with the atte
Open fractures of the leg.
Post - traumatic lengthy hand reconstruction.
Severe crushing injuries—Elbow surgery (with concomittant excess swell
Severe hypertension.
Skin grafts (to help distinguish all bleeding points).

22. POST TOURNIQUET
SYNDROME
Post - tourniquet syndrome (PTS) is manifested by pronounced and, at time

23. The complication occurs in patients who have had tourniquets applied for
Post - tourniquet syndrome is characterized by edema, stiffness, pallor, we

24. OTHER
COMPLICATIONS
1)Compartment syndrome.
2)Rhabdomyolysis.
3)Pulmonary emboli (rare complication).
4)Vascular complications can occur in patients with
severe arteriosclerosis or prosthetic grafts.
-Therefore, a tourniquet should not be applied over a
prosthetic vascular graft.

25. PREVENTIVE
MEASURES:
Medication history:A patient's drug history should detect the routine ing
History of hypertension.
Clotting time.
History of past thromboembolic occurrences.
Evidence of arterial calcification.

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