The use and precautions of pneumatic tourniquet
1. Use tourniquet correctly
(1) The tourniquet should be carefully checked before the operation, such as whether the air bag leaks, whether the pump is easy to use, and whether the air pressure gauge is accurate.
(2) Choose the appropriate pneumatic tourniquet according to the patient’s age, limb circumference, and patient’s physique.
(3) The place where the tourniquet is placed should be correct, and the tourniquet should be tied to the more abundant part of the limb muscles to prevent nerve damage. The upper limbs should be placed in the upper 1/3 of the upper arm, and the lower limbs should be placed near the groin at the base of the thigh.
(4) When tying the tourniquet, place a small sheet (cloth) under the tourniquet and keep the skin contact surface level. The tourniquet should be tied tightly and properly, and the ventilation tube should be placed at the proximal end of the limb to prevent contamination of the surgical field and facilitate pumping. It is best to wrap a fixed belt or bandage outside the pneumatic tourniquet to prevent it from rolling after inflation.
(5) Before the tourniquet is inflated, the limbs should be raised first. After the bleeding is completely expelled, the ventilation tube of the tourniquet should be connected to the air pressure gauge, and the air should be slowly injected into the tourniquet. Upper limb pressure should not exceed 40.0kPa (300mmHg) for adults, 26.7kPa (200mmHg) for children, lower limb pressures should not exceed 80kPa (600mmHg) for adults, and 33.3kPa (250mmHg) for children.
(6) Accurately record the inflation time of the pneumatic tourniquet, 1 hour for upper limbs and 1.5 hours for lower limbs. When the time is up, the surgeon should be notified in advance to prepare for deflation. If you need to continue using it, you should deflate for 5-10 minutes. Reinflate and re-record the time.
(7) When loosening the tourniquet, deflate slowly to avoid shock caused by a sharp drop in blood pressure. After the tourniquet is removed after the operation, check the patient’s skin for damage, and massage locally for several minutes if necessary. Second, the misunderstanding of the use of airbag tourniquets
1 Misunderstandings of strapping on the operating table
(1) In the operation of the middle and lower segment of the humerus and femur, in order to reduce bleeding, a sterile tourniquet is often needed, which is tied on the operating table by the surgeon. As a result, the tightness of the tourniquet is not guaranteed, and the amount of inflation cannot be determined, causing bleeding. There are even complications such as skin necrosis and nerve palsy;
(2) When expelling blood, the expelling belt leaves a distance of varying sizes between circles every week, forming an intermittent expelling blood, and the effect is extremely poor;
(3) Uneven force when driving the blood out, one winding and one slow, unable to continue using force, poor hemostasis effect;
(4) In mid-humeral surgery, in order to reduce bleeding, a sterile pediatric tourniquet is used to stop bleeding. Because the air sacs are short and narrow, the purpose of compression and hemostasis is not achieved, but more bleeding.
2 Misunderstandings of strapping under the surgical front desk
(1) The binding is too loose or the pressure is insufficient, and there is more bleeding;
(2) If the binding is too tight or the pressure is too high, it is easy to produce complications;
(3) The sterile towel wrapped around the limbs before tying is not flat, so that the force is uneven, and blisters are prone to occur; (4) The patient’s pain is unbearable if the tourniquet is used for more than the time limit;
(5) Improper binding position can compress nerves and cause paralysis;
(6) After inflation, the tourniquet swells or slips off, which delays the time;
(7) The connection between the ventilation tube and the hemostatic instrument is not tight or falls off halfway;
(8) Multiple limbs relax the tourniquet at the same time, causing a sharp drop in blood pressure and even shock.
Three, matters needing attention
1 Before using the tourniquet, carefully check whether there is any air leakage and whether the hemostatic instrument is flexible and practical, otherwise it should be replaced in time. 2 According to limbs and age, accurately select tourniquets (large, medium, and small).
3 The tightness of the strapping should be appropriate, so that it can hold a finger.
4 Before tying the tourniquet, wrap gauze or sterile towel to protect the limbs, and flatten them to prevent uneven force, which may cause blisters or blood stasis.
5 After binding, use gauze bandage to reinforce for two weeks to prevent swelling or slipping.
6 The sterile tourniquet can be tied by the hand-washing nurse on the operating table to assist the surgeon to ensure proper tightness. 7 Strictly control the use time limit of the tourniquet. The first use of a single limb should not exceed 90 minutes, the second use should not exceed 60 minutes, and the interval between the two should be 5-10 minutes.
8 When expelling blood, use uniform and continuous force. The overlap of the exsanguination band is greater than or equal to 1/3, and the blood is gradually expelled from the distal end to the proximal end of the limb to the edge of the tourniquet, and inflated to the required KPA to achieve sufficient hemostasis. .
9 Use tourniquets for multiple limbs at the same time. When relaxing, relax one limb first, and then relax the other limb after the blood pressure stabilizes. The use time limit of each limb is 60min. Prevents meridian ischemia for too long, necrosis of the limbs and sudden acceleration of effective circulating blood volume, which increases the burden on the heart.