Tourniquet

A tourniquet is a mechanical device that prevents the blood supply to the respective arm or leg during surgery on the extremities ( limbs ).

application

There are two main reasons for using a tourniquet:

1. Prevention of blood loss: The treatment of complicated bone fractures or difficult soft tissue interventions such as the removal of larger tumors can lead to extensive bleeding, which endangers the patient. Correct hemostasis at the beginning of the procedure is not possible or is so protracted that the intermittent loss of blood cannot be tolerated.
2. Keeping the operating area clear: Persistent small bleeding that cannot be stopped locally with reasonable effort leads to a confusing operating area and thus to the endangerment of important structures such as nerves.

execution

As close as possible to the trunk of the body, an inflatable cuff similar to the cuff of a blood pressure monitor is placed around the affected extremity and inflated to a pressure that is significantly higher than the patient's arterial systolic blood pressure . Since a reliable closure of the supplying arteries can only be achieved if the pressure applied to the artery exceeds the systolic blood pressure, the cuff pressure must be selected so that the pressure absorption of the soft tissue jacket (skin, subcutaneous fatty tissue, muscles) is also taken into account. An effective tourniquet is achieved in patients with normal blood pressure ( RR ≤ 150 mmHg) around 270 mmHg on the arm and around 400 mmHg on the leg.

Bloodlessness

In situations in which the operating field has to be viewed with particular care (for example operations on the nerves of the hand), the residual blood in the extremity, which is gradually escaping, can be noticeable in the operating field. In such cases, before closing the tourniquet, the blood is removed from the extremity by unwrapping it, for example using an Esmarch bandage . The same procedure is used to apply intravenous regional anesthesia .

Risks

The tourniquet's cuff must be placed absolutely smoothly around the extremity so that the pressure is built up as evenly as possible. Wrinkles create pressure points that can later manifest as tension bubbles or skin necrosis .

If so, tourniquet can trigger a thrombosis with the subsequent risks of pulmonary embolism or post-thrombotic syndrome .

Patients with peripheral arterial disease are at risk of embolism due to the detachment of plaques .

swell

• D. Schmidt, M. Zimmer: Surgery. Basic textbook health and disease , Urban & Fischer at Elsevier, 2004, ISBN 3-437-48110-X , p. 26

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !