Tourniquet cuff selection and placement
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:
The ACORN guideline, use of the pneumatic tourniquet, provides clear instruction on the safe use of the pneumatic tourniquet.
Risks
The following risks are associated with incorrect tourniquet cuff size and placement: nerve injury, post-tourniquet syndrome, compartment syndrome, pressure sores, subcutaneous fat necrosis, fatal or near-fatal pulmonary embolism and deep vein thrombosis after deflation.
Actions
Prior to tourniquet cuff placement, cuff selection, position and inflation pressures should be confirmed with the surgeon. Laterality should also be identified, or in the case of bilateral cuff placement, the operative limb with the cuff to be inflated first.
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