INTRAOPERATIVE TOURNIQUET USE Micah Reece. *A caveat  As we’ve learned, pneumatic tourniquets play an important role in regional/Bier blocks but such.

Slides:



Advertisements
Similar presentations
Dermatome Levels Soli Deo Gloria
Advertisements

Principles of Recovery Dr James F Peerless August 2014.
Intravenous regional anaesthesia Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab. DCA, Dip. Software statis tics PhD(physiology) Mahatma Gandhi.
Dr. Abdul-Monim Batiha Monitoring in Critical Care Dr. Abdul-Monim Batiha.
Arterial Blood Gas Assessments
Accelerated Ventilator Weaning Guideline A path to excellence! Click Here A path to excellence! Click Here.
Care of Patients with Shock
The Perioperative Nursing Role January 12th, 2009.
BIER BLOCK Developing Countries Regional Anesthesia Lecture Series Daniel D. Moos CRNA, Ed.D. U.S.A. Lecture 16 Soli.
Hemodynamic Monitoring By Nancy Jenkins RN,MSN. What is Hemodynamic Monitoring? It is measuring the pressures in the heart.
Anesthetic Management of Cardiac Rhythm Management Devices N746: Summer 2014 Jennifer Ranieri.
Objectives  Discuss how the progression of nurse anesthesia program curricula may impact clinical practice of the nurse anesthetist  Describe Regional.
Pre and Post Operative Nursing Management
Blood Pressure— The driving force Stephen Hales 1733 Blood pressure (hydrostatic pressure) is the force exerted by the blood against any unit area of vessel.
Chapter 26: Vital Sign Assessment
Patient Vital Signs DRAFT
 Temperature (T)  Pulse (P)  Respiration (R)  Blood pressure (BP)  Pain (often called the fifth vital sign)  Oxygen Saturation.
Pre and Post Operative Nursing Management
Hypertension A Case Study Jennifer Kitchen July 19, 2013.
Pre-operative Assessment and Intra operative Nursing Role
Monitoring of Patients during Anesthesia and Surgery Haim Berkenstadt MD Director, Department of Anesthesiology Deputy Director, The Israel Center for.
Waste Anesthetic Gases. The anesthetic gas and vapors that leak out into the surrounding room during medical and surgical procedures are considered waste.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Comprehensive Medical Assisting, 3 rd Ed Unit Four: Fundamentals of Clinical Medical.
Chapter 13 Vital signs.
How To Measure Vital Signs
Without reference, identify principles about Anesthesia Units with at least 70 percent accuracy.
VITAL SIGNS Vital signs are measures of various physiological statistics, often taken by health professionals, in order to assess the most basic body.
VITAL SIGNS BLOOD PRESSURE (BP).
ACCURACY IN BLOOD PRESSURE MEASUREMENT Importance of site and accuracy.
Conscious Sedation.
CONTROLLED HYPOTENSION and MINIMAL INFLATION PRESSURE: A NEW APPROACH FOR PNEUMATIC TOURNIQUET APPLICATION IN UPPER LIMB SURGERY Tuncali B, Karci A, Bacakoglu.
Intraoperative Recall
Chapter 16 Assessment of Hemodynamic Pressures
Copyright © 2008 Lippincott Williams & Wilkins. Introductory Clinical Pharmacology Chapter 21 Anesthetic Drugs.
MAINTAINING CARDIAC AND VASCULAR FUNCTION DR. IRENE ROCO ASST. PROFESSOR.
Angelique Davis.  Type I IgE or Non-IgE Allergic reaction  Type II IgG, IgM, Complement mediated Cytotoxicity; Blood reaction  Type III Immune complex.
PCI What You Need to Know!. What and Where Radial- advantages  Immediate ambulation  Easily compressible vessel  Less risk of nerve injury  Dual blood.
Signs we are ALIVE Vital Signs.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Comprehensive Medical Assisting, 3 rd Ed Unit Four: Fundamentals of Clinical Medical.
Pre-Operative and Post-Operative Care
Perioperative Nursing Care
1 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. Nursing Management: Postoperative Care Chapter 20.
The Postanesthesia Care Unit Ahmad abu assa. PACU Recovery from anesthesia can range from completely uncomplicated to life-threatening. Must be managed.
Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.
Department of Emergency Medicine Auckland City Hospital Ischaemic Arm Block Dr Peter Jones Emergency Medicine Specialist Auckland City Hospital.
Pre and Post-Operative Nursing Care
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 40 Nursing Care of the Perioperative Client.
ANESTHESIOLOGIST Lexi Northrup Writing 1010 December 17, 2013.
Hemodynamic Monitoring John Nation RN, MSN Thanks to Nancy Jenkins.
Anesthetic Considerations for One Lung Ventilation Julia E. Linton York College/ Wellspan Health Nurse Anesthesia Program.
Anesthesia. Preparation Removal of food and water is recommended for 12 hours prior to surgery Supplemental heat is also used to maintain the patient.
Pulse Oximetry. What is a Pulse Oximeter? A device that provides a non-invasive (does not break the patient ’ s skin or body openings) method of allowing.
Monitoring in Anesthesia Dr.Arkan Jaafar, M.D. Anesthesiologist,Medical college of Mosul.
Dexmedetomidine Lowers the Concentration of Anesthetic Required during Craniotomies below MAC Garett J. Pangrazzi, BS, Jacob A. Uhler, BA, Prashanth R.
Weaning From Mechanical Ventilation
Systemic Lupus Erythematosus Angelique Davis Q: Why does seal have scars on his face? A: Discoid Lupus.
Dr S Parthasarathy MD DA DNB PhD Dip. software statistics FICA
TOURNIQUET USE.
Vital Signs Assessment
INTRACRANIAL PRESSURE
Vital Signs: Blood Pressure
Pre-operative Assessment and Intra operative Nursing Role
Vital Signs: Blood Pressure
Intra operative & Post operative Nursing
Vital Signs: Blood Pressure
Anesthesia for Laparoscopical surgery
Pneumatic Tourniquets
MECHANICAL VENTILATION
Bier’s Block Rahaf Jreisat.
Presentation transcript:

INTRAOPERATIVE TOURNIQUET USE Micah Reece

*A caveat  As we’ve learned, pneumatic tourniquets play an important role in regional/Bier blocks but such use is outside the scope of this paper as the assigned topic is INTRAoperative tourniquet use (particularly with regards to orthopedic surgery)

So what is a pneumatic tourniquet?  Essentially an inflatable compression device of varying sizes containing:  Air compressor  Inflatable cuff  Connective tubing  Timer

Stryker SmartPump

How does it work?  Almost always inflated AFTER induction or block  Inflated to 100 mm Hg above systolic baseline for LE and 50 mm Hg above baseline for UE

How does it work?  Limb can be further exsanguinated via Esmarch bandage and elevation of extremity.

…But it can’t stay on forever  Most machines have a timer that will alarm after 60 minutes of inflation time  Current guidelines recommend max inflation time of 120 minutes before requiring a ten minute break for deflation of the cuff and reperfusion to the extremity

Why use these things?  Commonly used in orthopedic/extremity surgeries to accomplish three goals:  Minimize blood loss  Maintain a bloodless field  Aid in identifying vital structures

Why do WE care?! Anesthesia Considerations

MANY deleterious effects of inflation  Muscle breakdown and hypoxia begin almost immediately=cellular acidosis  Abolition of nerve conduction and somatosensory evoked potentials to effected area  Progressive sympathetic activation often manifests as marked hypertension, diaphoresis, and tachycardia

You’re not done yet! (Deflation)  Following deflation, patients will exhibit numerous transient CV changes:  lower core body temperature  decreased venous oxygen tension  sudden drops in arterial and pulmonary pressures  increased heart rate

Deflation Cont’d  Further hyperkalemia and myoglobinemia  Myoglobinuria  Metabolic acidosis  Think of tourniquet release as a “metabolic washout”  Respiratory Acidosis  Increased minute ventilation in a spontaneously breathing patient Lab changesRespiratory Changes

So what is our role?  Vigilant monitoring of hemodynamic status  Cautious use of pressors depending on when cuff is inflated/deflated  Ensure proper padding of limb, appropriate tourniquet size, minimize inflation time

Cont’d  Careful monitoring of pertinent labs (i.e. potassium, myoglobin, ABG)  Assess for any lingering post- operative pain or parasthesias

Remember!  It’s hard to have tourniquet-induced complications if the tourniquet isn’t being used. Coordinate with the surgical team to keep inflation time to an absolute minimum.

L is for “litigation”  It is very important for the nurse anesthetist to accurately document inflation AND deflation time  Make sure your times match those of the OR record  Also a good idea to chart that you notified surgeon at intervals of time and the message was acknowledged

Questions?

The End

References Barash, P. G., Cullen, B. F., Stoelting, R. K., Cahalan, M. K., Stock, M. C., & Ortega, R. (2013). Clinical Anesthesia (7th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Butterworth, IV, J. F., Mackey, D. C., & Wasnick, J. D. (2013). Morgan & Mikhail’s Clinical Anesthesiology (5th ed.). [AccessMedicine]. Retrieved from Davis, R., Keenan, J., Meza, A., Danaher, P., Vacchiano, C., Olson, R. L., & Maye, J. (2002, August). Use of a simple forearm tourniquet as an adjunct to an intravenous regional block. AANA Journal, Retrieved from arm_tourniquet0802_p pdf

References Cont’d Hoerneman, D. W. (1982, December). Orthopedic surgery: Some anesthetic considerations. Journal of the American Association of Nurse Anesthetists, Retrieved from opedic_surgery_1282_p555.pdf Nagelhout, J. J., & Plaus, K. L. (2013). Nurse Anesthesia (5th ed.). St. Louis, MO: Elsevier Saunders.