Tourniquet Systems Pose Challenges

Abstract

Q: We constantly have work orders on our tourniquet systems in the operating room. Do you have any suggestions on how we can reduce work orders?A:. We have struggled with this at our hospital and have developed a system that reduces downtime and surgeon frustration with tourniquet systems. These systems have become much more high tech than they were 10 to 15 years ago. In the past, the system was a cuff connected to a pressure regulator. When the pressure reached a preset pressure, the valve closed and held the cuff at the pressure it was set at until the valve was manually released. The good news is not much has changed, although there are more bells and whistles, along with some added safety features, that make these devices seem more sophisticated than earlier versions.The five basic components of most tourniquet systems—inflatable cuff, pressure display, compressed gas source, pressure regulator, and connection tubing—can lead to numerous issues. A variety of devices now use an electrical pump which compresses ambient air. If the device does not have this technology, then most likely it needs to be connected externally to some compressed gas source such as nitrogen. Regardless of the source of compressed gas, the goal is to deliver a carefully regulated amount of pressure to the tourniquet cuff. The pressure display is an extremely simple device that digitally or pneumatically displays the pressure at the tourniquet cuff. Some devices today can supply and read two cuffs at time, in which case there would be a dual display. Whichever type your facility has, the goal is to know exactly what the cuff pressure is set for and what the pressure actually is. The control board is found on “microprocessor controlled” tourniquet systems. It is nothing more than a board that everything plugs into, sits on, or goes through. And it does that so there is a control point or a “chief” to make sure all tasks are completed. The pressure regulator's sole purpose is to adjust and control the pressure in the cuff. Older devices, which were not “computerized,” were comprised of valves that mechanically responded to pressure. Most devices today are microprocessor controlled. They can be microprocessor controlled because the pressure regulator and pump are combined into one instrument. This microprocessor-controlled regulator is a very finite instrument, which can detect very small changes in pressure and respond to those changes accordingly, adding or releasing pressure from the cuff.Modern tourniquets also offer many safety features. Some of these features include interlocks that cause the cuff to stay pressurized should the power inadvertently be switched off or if the unit is put in “stand by.” Some devices warn users that the tubing is kinked or occluded, preventing the instrument from displaying and resulting in invalid pressure. Alarms are also included on some tourniquets that alert the user to leaks in tubing or the cuffs.Some pieces of a tourniquet which are most often overlooked, and always need attention, are the connection tubing and the inflatable cuff. Most tubing either utilizes a Positive Locking Connector or a Luer-lock connector. It does not matter what connector is utilized, the connection must be a tight fit to prevent leaks.Some devices automatically calibrate themselves every time they are turned on. Other units must have a certain hose connected to calibrate them.Regardless of which technique is used, it is very important that the specific hose for that unit is always used because this will affect the calibration and in return affect the pressure in the cuff, ultimately leading to blood leaking. In my experience, blood leaking is very annoying to a surgeon who is trying to perform a specific surgery.Cuffs may not be considered a biomed issue, but I work under the premise that building a bridge with staff always results in a positive outcome. In my shop, cuffs are a biomed issue. The right cuff for the right procedure is as important as the right tool for the right job. Familiarize yourself with cuff sizes and when and where they are used. Most sales representatives are eager to explain this to you. Make sure the right cuffs are available and serviceable. Check that cuff to ensure the Velcro is good and not filled with lint. Make sure the o-ring on the cuff is flexible and moves easily. Replace it immediately if it doesn't move easily or is cracked. These little 10-cent o-rings will cause a lot of issues if they are not serviceable.Here are some simple things a biomed can do to maintain this equipment:When our facility adopted this process, our work orders on tourniquets dropped exponentially. And here is the best part, surgeon confidence with our particular device and manufacturer increased.