Survey of Tourniquet Use

Survey of Tourniquet Use in Upper and Lower Limb Surgery

Posted on January 16, 2014. Filed under: Survey of Tourniquet Use, Tourniquet Safety | Tags: , , , , , , |

A recent publication in the Irish Journal of Medical Science [1] surveyed upper and lower limb tourniquet use among Irish orthopaedic surgeons.

Ninety-two Irish orthopaedic consultants were sent a 15-survey question on tourniquet use.  Sixty respondents returned a completed survey of which 49 used both upper arm and thigh tourniquets.

The survey showed that few surgeons use contoured tourniquet cuffs on patient limbs and a wide range of “most commonly used cuff pressures” was reported with few surgeons taking limb occlusion pressure (LOP) or systolic blood pressure into consideration when selecting tourniquet pressure.

Accordingly, tourniquet-related problems and concerns were focused on cuff fit and nerve injury: Thigh cuff users reported higher rates of poor cuff fit when compared with upper arm cuff users (Table 4). The two respondents who used a contoured cuff for both upper arm and thigh reported that they rarely or never experienced poor cuff fit. Eighty-five percent of respondents were concerned with a tourniquet-related complication during tourniquet use. Nerve injury was the most common concern, with 41 % of respondents ranking nerve injury as their primary concern when using a tourniquet.”

Based on the results of the survey, the recently published study concluded that “there is a wide variation in tourniquet practice by Irish orthopaedic surgeons.  Based on published studies of LOPs, this study suggests that some of the tourniquet cuff inflation pressures used may be higher than necessary.  Guidelines for optimising cuff pressure and technique should be established to minimise the risk of complications.”

The full abstract of the publication in the Irish Journal of Medical Science is given below. [1]

 

Background:  Tourniquet use in orthopaedic surgery is common practice. However, the technique varies among Irish orthopaedic surgeons and there are no standard guidelines. 

Aim: To analyse trends in tourniquet use among Irish orthopaedic surgeons. 

Methods:  Ninety-two Irish orthopaedic consultants were sent a 15-survey question about tourniquet use by post. 

Results:  Sixty respondents returned a completed survey, of which 49 (81% of respondents) used both upper arm and thigh tourniquets. A variation in tourniquet pressure settings and techniques used was reported. Thirty-nine surgeons (65% of respondents) use a tourniquet pressure range of 201-250 mmHg for the upper arm and 30 surgeons (50% of respondents) use a range of 251-300 mmHg for the thigh. Thirty-six surgeons (60 % of respondents) experienced a complication secondary to tourniquet use, the most common complications being nerve and skin injury. 

Conclusions:  Based on published studies of limb occlusion pressures, this study suggests that some of the tourniquet cuff inflation pressures used may be higher than necessary. Guidelines for optimising cuff pressure and technique should be established to minimise the risk of complications. This study may help determine direction for future research on tourniquet use.

 

References

[1] Cunningham L, McCarthy T, O’Byrne J. A survey of upper and lower limb tourniquet use among Irish orthopaedic surgeons. Ir J Med Sci. 2013 Sep;182(3):325-30.

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