Understanding and Optimizing Tourniquet Use During Extremity Surgery

Knee arthroscopy is one of the most common surgical procedures in orthopaedics and especially in sports medicine. Portal problems and effusion after knee arthroscopy have been reported. The fluid retention within the joint in knee arthroscopy can affect clinical outcomes, but there is no consensus on portal management. The studies of portal management in knee arthroscopy have mainly addressed wound healing and cosmetic problems. There is insufficient information in the literature about whether the irrigation fluid used in this effusion contributes to the process. This study investigates whether arthroscopic irrigation fluid is retained in the joint and whether portal-closure management has an effect on effusion. In this randomized, prospective study, 91 patients (46 [50.5%] sutured-portal group and 45 [49.5%] open-portal group) were included. Suprapatellar knee-diameter measurement and the number of times the dressing was changed were used to assess intra-articular fluid collection. The visual analog scale (VAS) score, Oxford knee score, and Knee Society score were used to evaluate knee problems. All portal wounds in both groups healed without any problems. Superficial or deep infection was not observed in either group. There was no statistically significant difference in VAS score, Oxford knee scores, and Knee Society scores between groups. Although there was a decrease in the knee diameter of both groups between the early postoperative period and first postoperative day, a statistically significant difference in knee diameter was found, especially in the open-portal group. There was a significant difference between the groups in terms of the number of dressings used in the first 24 hours after surgery. Leaving portals open may be effective in preventing intra-articular fluid retention. We thus advise leaving the arthroscopy portals open with just a simple dressing for selected patients.

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“…), because the use of a tourniquet in these cases may increase the risk of DVT and pulmonary embolism. 21…”

Section: Discussionmentioning

confidence: 99%

Should We Suture Arthroscopic Portals? Effects on Intra-articular Fluid Retention

2021

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“…Additional training is required for all medical personnel participating in the PTs application to improve patient treatment experiences, surgical outcomes, and promote safe perioperative care [ 7 – 9 ]. At the same time, the risks of PTs usage, indications, and contraindications are still discussed, and evidence is based mostly on small studies or case reports [ 10 ], which requires caution in approaching training programs and individual education.…”

Section: Introductionmentioning

confidence: 99%

Knowledge, attitudes, and practices of orthopedic operating room personnel regarding the use of pneumatic tourniquets

Zu,

Zhang,

Chen

et al. 2024

PLoS ONE

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Introduction Pneumatic tourniquets (PTs) play a crucial role in hemostasis during orthopedic surgery. This study aimed to investigate the current knowledge, attitudes, and practices (KAP) of orthopedic operating room personnel concerning the use of PTs. Methods This cross-sectional study was conducted from Jul. 2023 to Aug. 2023. An online questionnaire was used to collect demographic information and KAP score data of the orthopedic operating room personnel from Hangzhou Regional Hospitals. Results A total of 336 participants included orthopedic physicians (37.8%), orthopedic nurses (31.5%), anesthesiologists (8.9%), operating room nurses (19.9%) and medical students (1.8%). The median knowledge score was 28.5 (24, 32), with a maximum score of 38; the median attitude score was 31 (28, 35), of a maximum of 35; the median practice score was 41 (36, 44), of a maximum of 45. Correlation analysis showed links between knowledge and attitude (r = 0.388, p<0.001), knowledge and practice (r = 0.401, p<0.001), and attitude and practice (r = 0.485, p<0.001). Multivariate logistic regression analysis confirmed that female gender (OR = 0.294, 95% CI: 0.167–0.520; p<0.001), working in a specialized hospital (OR = 0.420, 95% CI: 0.219–0.803; p = 0.009), and occupation as a surgical anesthesiologist (OR = 3.358, 95% CI: 1.466–7.694; p = 0.004) were associated with better knowledge scores. A higher educational degree (OR = 0.237, 95% CI: 0.093–0.608; p = 0.003) was associated with better practice scores. No previous training was associated with lower knowledge (OR = 0.312, 95% CI: 0.187–0.520; p<0.001) and practice (OR = 0.325, 95% CI: 0.203–0.521; p<0.001) scores. Conclusion Orthopedic personnel in this study had acceptable knowledge, attitude, and practice concerning the use of PTs; additional training and guidance might enhance proficiency.

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“…Tourniquet use and haemorrhage-control training have shown a reduction in mortality from approximately 10 to 16% in the battlefield, which can be mirrored in injured victims in civilian contexts, where the literature is more limited (Goolsby et al, 2019;Kotwal et al, 2011). Whereas it is true that adequate knowledge and training of nurses and medical staff has shown to be effective for safe use of tourniquet (Jensen et al, 2019), further understanding of their use 4 in other scenarios, such as MCIs or disasters where emergency teams need to take quick and efficient decisions, is still needed (Moore, 2017;Pepper et al, 2019).…”

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“…Having said that, there is still a controversy over the use of tourniquets due to their potential risks caused by inappropriate usage, lack of training or prolonged use (Jensen et al, 2019;McCarty et al, 2019). These may lead to some of adverse effects, which entail permanent nerve and muscle injury, ischemia, vascular injury or skin necrosis (Ahn et al, 2019;Spruce, 2017).…”

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confidence: 99%

Tourniquets as a haemorrhage control measure in military and civilian care settings: An integrative review

Román

Rodriguez-Alvarez

Bertini-Perez

et al. 2021

Journal of Clinical Nursing

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Aims and objectives: The aim of review was to describe and synthesise the evidence on the use of tourniquets to control haemorrhages, summarising both civilian and military use.Background: Trauma-related haemorrhage constitute one of the most preventable deaths among injured patients, particularly in multi-casualty incidents and disasters. In this context, safe instruments such as tourniquets are essential to help healthcare professionals to minimise loss of life and maximise patient recovery. Design and Methods: An integrative review was conducted in Medline, Nursing & Allied Health Premium, and Health & Medical Collection, using published data until March 2021 and following the PRISMA guidelines. Results: A total of 25 articles were included. Evidence has been synthesised to understand the use of different types of tourniquets, environment of application, indication for their placement and potential complications associated with tourniquet placement. Conclusions: Commercial tourniquets such as Combat Application Tourniquet orEmergency Tourniquet models are a valuable and safe instrument for haemorrhage control in both military and civilian out-of-hospital care settings. Nurses, as part of emergency teams, and other professionals should be aware that there is a possibility of adverse complications, but they are directly proportional to the time of tourniquet placement and generally temporary. In addition, national and international guidelines ensure the need for all civilian emergency services to be equipped with these devices, as well as for the training of healthcare professionals and first responders in their use.Relevance to clinical practice: Despite the lack of complications in the use of tourniquets in these cases, their use has been a matter of debate for decades. In this sense, this review 2 yields up-to-date guidelines in the use of tourniquets, their recommendations and their significance among professionals to manage complicated situations.

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Understanding and Optimizing Tourniquet Use During Extremity Surgery

Cited by 7 publications

References 39 publications

Should We Suture Arthroscopic Portals? Effects on Intra-articular Fluid Retention

Should We Suture Arthroscopic Portals? Effects on Intra-articular Fluid Retention

Knowledge, attitudes, and practices of orthopedic operating room personnel regarding the use of pneumatic tourniquets

Tourniquets as a haemorrhage control measure in military and civilian care settings: An integrative review

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