What are the guidelines for safely performing a tourniquet test?

Guidelines for Safely Performing a Tourniquet Test

Tourniquets should only be applied when direct pressure fails to control severe limb hemorrhage, in cases of amputation, when a foreign body is present in the wound, when there is lack of radial pulse, or when multiple simultaneous actions must be performed. 1

Indications for Tourniquet Use

• Tourniquets are indicated in cases of active limb hemorrhage when direct compression is ineffective 1
• Appropriate for amputations, presence of foreign bodies in hemorrhagic wounds, absence of radial pulse, or when multiple simultaneous actions must be performed 1
• Tourniquets have demonstrated high rates of hemorrhage control (96% success rate) in prehospital settings 2

Proper Application Technique

• Apply the tourniquet proximal to the bleeding site 1
• Ensure the tourniquet is tight enough to abolish distal pulses 1
• Document the time of application clearly and communicate this to all healthcare providers 1
• Proper training is essential for effective application 1, 3

Monitoring and Reassessment

• Re-evaluate the effectiveness, usefulness, and location of the tourniquet as soon as possible after application 1
• Reassess for arterial occlusion within 5-10 minutes after application, as significant pressure loss can occur within minutes 4
• Maintain the shortest possible application time and smallest possible area of ischemia to limit morbidity 1
• Avoid iterative tourniquet releases as they can aggravate local muscle injury and systemic rhabdomyolysis 1

When to Remove or Convert a Tourniquet

• If a tourniquet appears mandatory (hemorrhagic shock, cardiac arrest), apply a second tourniquet distal to the first before loosening the proximal one to avoid recurrence of bleeding 1
• When reassessing, gradually loosen the tourniquet while monitoring for resumption of bleeding 1
• If bleeding resumes, immediately retighten the tourniquet 1
• If bleeding has stopped, consider converting to a pressure dressing 5

Potential Complications and Prevention

• Complications may include temporary paresthesia, ecchymosis, need for fasciotomy, and compression nerve injury 2
• Serious complication rates are relatively low (7.7%) when tourniquets are properly applied 2
• Improper or prolonged placement can lead to nerve damage and limb ischemia 3
• The risk of complications increases with duration of application 3, 4

Special Considerations

• Different tourniquet types (elastic vs. non-elastic) have varying rates of pressure loss; elastic tourniquets generally have less pressure loss 4
• Pressure loss is faster on thighs than arms, requiring more vigilant monitoring 4
• When applied properly, tourniquets do not appear to increase the risk of limb loss 1, 6
• In mass casualty incidents or unsafe environments, more liberal use of tourniquets may be warranted 1, 5

Documentation Requirements

• Record the time of tourniquet application 1
• Document the type of tourniquet used 4
• Note the location of application 1
• Record all reassessments and any adjustments made 1