Basics of nail surgery
Archana Singal, Shekhar Neema, Piyush Kumar in Nail Disorders, 2019
A tourniquet is a mechanical device used for the temporary control of the blood circulation, especially used in surgeries of extremities. The nail derives its blood supply from the lateral digital arteries, which give rise to numerous branches and proximal and distal arcades, which anastomose extensively.9 All nail surgical procedures require the use of a tourniquet. The nail bed, being a very vascular structure, needs to be exsanguinated at the start and then a tourniquet needs to be tied at the base. A number of tourniquets have been described, including a Foley’s catheter, a Penrose drain, a rubber strip, or a rubber band.10 An ideal material for use as tourniquet should not be thin, twisted, and constrictive like a rubber band. It should be sterile as it comes in close contact with the operative field.
Inside the Operating Theatre
Manoj Ramachandran, Tom Nunn in Basic Orthopaedic Sciences, 2018
Tourniquets are used to create a bloodless field in which to operate. This aids visualization and improves cementation. Pneumatic tourniquets are most often used and allow control of the pressure applied. Use of tourniquets can be hazardous, and the minimum pressure should be applied for the minimum length of time possible. The widest tourniquet possible should be used, and it should be at least half the diameter of the limb to reduce the risk of local pressure complications. When selecting tourniquet length there should be at least 3 inches (7.6 cm) of overlap of the tourniquet ends for sufficient hold, but ideally no more than 6 inches (15.2 cm) to avoid skin wrinkling under the tourniquet and possible local pressure complications related to this. It is applied well away from the operative field over two layers of padding; more layers of padding may reduce pressure transfer to the vessels and negate the effectiveness of the tourniquet. Contoured tourniquets can be useful in particularly obese or muscular patients to improve contact area. Systemic antibiotic prophylaxis must be administered at least 5 minutes before cuff inflation.
Shock Management
Ian Greaves, Keith Porter, Jeff Garner in Trauma Care Manual, 2021
This subject is covered in detail in Chapter 8. A summary is provided here. It is easy to underestimate the extent of external blood loss. A large amount of the evidence may be left at the scene and bleeding—especially from head wounds—can be insidious. Manual pressure applied to bleeding points will normally control venous bleeding, particularly when combined with elevation of the wound above the level of the heart. This is best achieved with the patient lying supine. When dealing with arterial bleeding, however, tourniquets are often necessary. Limb arterial bleeding is best controlled in the resuscitation room by using a pneumatic limb tourniquet inflated above systolic pressure. Where this is not possible, a triangular bandage should be applied over the dressing covering the wound such that its knot lies above the bleeding point. If a rigid bar is then incorporated under the knot and twisted, increased pressure can be exerted.37 Occasionally a topical haemostatic agent may be required (Chapter 8). The time a tourniquet is applied should be clearly marked in the patient’s notes so that inappropriately long limb ischaemia is avoided. Control of external haemorrhage forms an essential part of the primary survey. In cases where the external haemorrhage is associated with compound fractures, appropriate splintage must be applied, although the timing of this must be judged according to clinical priority.
D-dimer: Preanalytical, analytical, postanalytical variables, and clinical applications
Published in Critical Reviews in Clinical Laboratory Sciences, 2018
Julien Favresse, Giuseppe Lippi, Pierre-Marie Roy, Bernard Chatelain, Hugues Jacqmin, Hugo ten Cate, François Mullier
Tourniquets are conventionally used to temporarily obstruct the vein flow and thereby assist the phlebotomist to identify vein access. It is commonly recommended that the tourniquet should be removed as soon as the needle is in the vein or when the first tube starts to fill and that it should never remain in place for more than 1–2 min [21,25]. The most important drawbacks of prolonged tourniquet placement include hemoconcentration and clot formation, which may jeopardize the quality of coagulation testing [21,25,32]. More specifically, Lippi et al. observed that D-dimer values (Mini Vidas® Immunoanalyzer) were significantly increased, by 13.4%, when measured in samples collected after 3 min of venous stasis [32]. Lower differences were also observed after a 1-min stasis (mean increase of 7.9%) [32].
Minimally invasive isolated limb perfusion – technical details and initial outcome of a new treatment method for limb malignancies
Published in International Journal of Hyperthermia, 2018
Roger Olofsson Bagge, Per Carlson, Roya Razzazian, Christoffer Hansson, Anders Hjärpe, Jan Mattsson, Dimitrios Katsarelias
The technique of ILP was pioneered in the 1950s by Creech and Krementz [10] and offers the benefit of a regional delivery of high doses of a chemotherapeutic agent that can reach 20–100 times higher concentrations compared to systemic intravenous delivery [11]. The method requires vascular dissection of the inflow and outflow vessels of the extremity and intraluminal placement of large bore vascular catheters [10]. A tourniquet is applied proximally to the vascular access to further isolate the extremity by compression of collateral vessels. The catheters are connected to an extracorporeal by-pass heart-lung machine and the extremity is then perfused with heated chemotherapeutics for 60–90 min. The extremity is finally rinsed with 2–3 L of crystalloid solution, the catheters are removed and the artery and vein are repaired, followed by fascia and skin closure.
Tourniquet Application for Bleeding Control in a Rural Trauma System: Outcomes and Implications for Prehospital Providers
Published in Prehospital Emergency Care, 2022
Hala Bedri, Hadeal Ayoub, Jacklyn M. Engelbart, Michele Lilienthal, Colette Galet, Dionne A. Skeete
Uncontrolled major bleeding leading to hemorrhagic shock is one of the leading causes of preventable death in the trauma setting (1). In fact, hemorrhage is responsible for up to 40% of trauma deaths (2–4). Recent military studies show that tourniquet use before the onset of shock is associated with better survival outcomes counteracting historical concerns (5,6). Furthermore, prehospital tourniquet application for hemorrhagic control in limb trauma has been associated with better survival than tourniquets applied in the emergency department (6). As a result, tourniquet use for hemorrhage control in civilians has been increasingly utilized by emergency responders (7,8). The revival of tourniquet use in the civilian population was evaluated by Schroll et al. who analyzed 197 adult patients from nine urban Level 1 trauma centers (9). They found that the mean time from tourniquet placement to emergency department arrival was 48 minutes and concluded that tourniquets were applied safely and effectively in 88.8% of the patients. Similar safety and effectiveness results were observed by Kue et al. (10). Tourniquet use in the civilian population is now broadly accepted in the US and abroad (4,11,12).