Intraoperative Tourniquet Use - PowerPoint Presentation

522 views
Uploaded On 2017-01-19

Intraoperative Tourniquet Use - PPT Presentation

Micah Reece A caveat As weve learned pneumatic tourniquets play an important role in regionalBier blocks but such use is outside the scope of this paper as the assigned topic is INTRAoperative ID: 511557

inflation tourniquet deflation amp tourniquet inflation amp deflation time aana www retrieved cont

Link:

Copy

Embed:

<iframe width="560" height="315" src="https://www.docslides.com/embed/511557" frameborder="0" allowfullscreen></iframe>

Download Presentation from below link

Download Presentation The PPT/PDF document "Intraoperative Tourniquet Use" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.

Presentation Transcript

Slide1

Intraoperative Tourniquet Use

Micah ReeceSlide2

*A caveat

As we’ve learned, pneumatic tourniquets play an important role in regional/Bier blocks but such use is outside the scope of this paper as the assigned topic is

INTRAoperative

tourniquet use (particularly with regards to orthopedic surgery)Slide3

So what is a pneumatic tourniquet?

Essentially an inflatable compression device of varying sizes containing:

Air compressor

Inflatable cuff

Connective tubing

TimerSlide4

Stryker SmartPumpSlide5

How does it work?

Almost always inflated AFTER induction or block

Inflated to 100 mm Hg above systolic baseline for LE and 50 mm Hg above baseline for UESlide6

How does it work?

Limb can be further

exsanguinated

via

Esmarch

bandage and elevation of extremity.Slide7

…But it can’t stay on forever

Most machines have a timer that will alarm after 60 minutes of inflation time

Current guidelines recommend max inflation time of 120 minutes before requiring a ten minute break for deflation of the cuff and reperfusion to the extremitySlide8

Why use these things?

Commonly used in orthopedic/extremity surgeries to accomplish three goals:

Minimize blood loss

Maintain a bloodless field

Aid in identifying vital structuresSlide9

Why do WE care?!

Anesthesia ConsiderationsSlide10

MANY deleterious effects of inflation

Muscle breakdown and hypoxia begin almost immediately=cellular acidosis

Abolition of nerve conduction and

somatosensory

evoked potentials to effected area

Progressive sympathetic activation often manifests as marked hypertension, diaphoresis, and tachycardiaSlide11

You’re not done yet! (Deflation)

Following deflation, patients will exhibit numerous transient CV changes:

lower core body temperature

decreased venous oxygen tension

sudden drops in arterial and pulmonary pressures

increased heart rateSlide12

Deflation Cont’d

Further hyperkalemia and

myoglobinemia

Myoglobinuria

Metabolic acidosis

Think of tourniquet release as a “metabolic washout”

Respiratory Acidosis

Increased minute ventilation in a spontaneously breathing patient

Lab changes

Respiratory ChangesSlide13

So what is our role?

Vigilant monitoring of hemodynamic status

Cautious use of

pressors

depending on when cuff is inflated/deflated

Ensure proper padding of limb, appropriate tourniquet size, minimize inflation timeSlide14

Cont’d

Careful monitoring of pertinent labs (i.e. potassium,

myoglobin

, ABG)

Assess for any lingering post-operative pain or

parasthesiasSlide15

Remember!

It’s hard to have tourniquet-induced complications if the tourniquet isn’t being used. Coordinate with the surgical team to keep inflation time to an absolute minimum.Slide16

L is for “litigation”

It is very important for the nurse anesthetist to accurately document inflation AND deflation time

Make sure your times match those of the OR record

Also a good idea to chart that you notified surgeon at intervals of time and the message was acknowledgedSlide17

Questions?Slide18

The EndSlide19

References

Barash

, P. G., Cullen, B. F.,

Stoelting

, R. K.,

Cahalan, M. K., Stock, M. C., & Ortega, R. (2013).