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Tourniquets are compression devices that prevent blood flow to a limb by constricting the blood vessels. Their use dates back thousands of years, with Alexander the Great’s army known to have applied tourniquets to staunch blood loss in injured soldiers, and they remain a major lifesaver on the modern battlefield.
Care must be taken when using any type of tourniquet – applying too tightly, or not tightly enough, and for too long, can lead to complications including permanent nerve and muscle injury, skin necrosis, blood vessel damage, compartment syndrome and reperfusion injury.
Taking blood used to be the preserve of the phlebotomist, but it’s now a routine part of the nurse’s role. Partially blocking venous blood flow with a tourniquet causes the blood to pool, making the vein easier to access and draw blood from. A scoping review conducted in 2019 found that of 1,479 tourniquets tested for microbacterial contamination, 29.8% were harbouring gram-positive staphylococci, so cleaning with an alcohol wipe between patients is essential.
Catastrophic arterial or venous haemorrhage can result in a 40% loss of blood volume in 3-4 minutes, leading to hypovolaemic shock. In out-of-hospital emergency care, use of a tourniquet by first responders is only advised as a last resort when direct pressure has failed to control bleeding, but it can be the difference between life and death.
Occluding blood flow to a limb with a surgical tourniquet creates a bloodless operating field, which both reduces operative blood loss and enables the surgeon to work with greater accuracy and speed. It can also be used to administer intravenous regional anaesthesia (IVRA or Bier block).
During low-intensity rehabilitation exercise, constricting blood flow with a tourniquet accelerates the growth of muscle size and strength in the recovering limb.
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