Cuff inflation
You are the circulating nurse caring for an obese patient undergoing bilateral total knee replacement. Tourniquet cuffs are to be placed on both operative limbs. Outline the risks associated with each of the following and the steps you would take to minimise patient injury. Provide rationales for your actions.
What will be an ideal response?
Answer:
Risks
Intravascular thrombosis and formation of embolus occur when limbs are not fully exsanguinated prior to cuff inflation.
Inflating the cuff on both limbs in rapid succession causes a shift of approximately 800 mL of blood volume to the central circulation. This can lead to a pronounced elevation in blood pressure due to the decrease in effective circulation. Elderly patients undergoing bilateral total knee replacement are at particular risk due to limited cardiovascular reserve and inability to cope with the stress of such large fluid shifts.
Actions
Elevate the lower limb for three to five minutes before inflating the cuff.
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