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Complications Associated with Tourniquet Use

Over the past few centuries, tourniquets have been associated with the battlefield, a device that has been either harmful or lifesaving. Soldiers were given tourniquets in their pockets with very little training on their use, particularly when they were to be used. In a hospital setting, tourniquets are often used for venipuncture, and much like the battlefield, guidelines are unclear on safe use. Phlebotomists may use unconventional materials for tourniquets (e.g., gloves) and procedures usually lack safeguards against forgetting tourniquet removal.

In a recent query of the CHPSO database, 836 events were returned with the word “tourniquet.” (The query also captured the numerous misspellings of tourniquet.)

A table below highlights a breakdown of the first 100 events:

Category Number of Events Associated with Category
Events associated with tourniquets left on patient for an extended period of time 60
Events with the words “purple” or “red” or “blue” or “black” or “discolor” 38
Events associated with patient complaining of pain 16
Events with indentations left on skin 9
Events with the words “dusky” or “bruise” 8
Events with the word “swollen” 8
Patient transferred from other department (Labs or ED to ICU or CCU) or from night to day shift 7
Events associated with hidden tourniquets (under name tag, BP cuff, scrub, gown, sleeve, while bathing patient) 4
Events with the word “blister” 3
Events associated with family member noticing tourniquet left behind 2
Events associated with patients unable to communicate 2
Events associated with pressure ulcers 1
Events associated with staff indicating time was unknown 1
Events associated with VTE 1
Time range tourniquets were left on (of those indicated on event report) 15 minutes – 10 hours
Tourniquet colors mentioned blue, orange
Tourniquet locations mentioned forearm, hand, upper arm, wrist

While a majority of these events did not involve harm, there was one in the sample that lead to venous thromboembolism (VTE) and another that lead to a pressure ulcer. In most of these events, nurses who discovered the tourniquet immediately removed it and assessed the area, typically a discolored ring around the skin, and applied ice.

Awareness of this risk and recommendations will help, including a notation on a checklist or coordinating a strategy with the lab team to collect the tourniquet with the sample. One hospital system will share their efforts to reduce tourniquets left behind, such as having the lab team collect the tourniquet with the sample and adopting a brightly colored and super long tourniquet. 

CHPSO is also interested in learning whether your facility has implemented an initiative to reduce the number of tourniquets left on patients. Please contact info@chpso.org for more details.

Resources

World Health Organization Guidelines on Drawing Blood: Best Practices in Phlebotomy. (2010). World Health Organization, 2. Available online: https://www.ncbi.nlm.nih.gov/books/NBK138665/

Welling, David R. et al. A brief history of the tourniquet. (2012). J Vasc Surg, 55(1):  286 – 290. Available online: http://www.jvascsurg.org/article/S0741-5214(11)02470-0/pdf

Pennsylvania Patient Safety Authority. (2005). Forgotten but not Gone: Tourniquets Left on Patients. Pennsylvania Patient Safety Advisory, 2(2): 19-21. Available online: http://patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2005/jun2(2)/Pages/19.aspx

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