Tourniquets: Always Necessary, Sometimes Forgotten

Throughout history, tourniquets have been used to restrict blood flow. It's one of the simplest and most effective medical devices ever created, yet has changed very little over time. While the material tourniquets are constructed from have evolved from vines and rope to a non-latex elastomers of many colors, little else has changed.  Because they constrict circulation, tourniquets save lives by stopping hemorrhages, and make venipunctures and IV therapy possible. 

Tourniquets also have a dark side.

When forgotten after a venipuncture, a tourniquet that continues to restrict blood flow often leads to deep vein thrombosis (DVT), a dangerous and life-threatening complication that can cause permanent injury, even death. 

National statistics are hard to come by, but healthcare facilities in the state of Pennsylvania alone reported 125 incidents of forgotten tourniquets in one year. In one third of the incidents, tourniquets were left on up to 18 hours. Extrapolating that statistic to the entire US, healthcare professionals forget tourniquets on nearly 3,000 patients every year. Many lead to complications and litigation. Complications include pain, swelling, skin sores, varicose veins, post-thrombotic syndrome, amputation, pulmonary embolism and death.

Performing venipunctures without tourniquets is not an option. Constriction of the circulation causes veins to distend as they fill up with blood that can no longer circulate. Distended veins are easier to palpate and access. The standards also require a thorough survey of available veins so that those most likely to be near nerves can be avoided. Without tourniquet constriction, a thorough survey cannot be conducted. [Editor's Note: many are under the false impression that lactates must be drawn without a tourniquet. However, no study has shown lactates to be affected by tourniquets applied for one minute, as is the case for routine phlebotomies. Only when left on for five minutes or longer, which is against the standards, are lactates affected.]

To prevent forgotten tourniquets and the complications that can ensue, facilities should adopt aggressive strategies. Some suggestions include:

• using neon- or brightly colored tourniquets that are easier to notice before leaving the patient;
• adding a step to the venipuncture procedure mandating a visual check for the tourniquet before leaving or dismissing patients;
• instituting effective consequences for those leaving tourniquets in place after the draw;
• request patients who are willing and able to count down from 60 after the tourniquet is applied as an audible reminder to the phlebotomist that the tourniquet should be released.

Deep vein thrombosis is a life-threatening risk everyone who draws blood samples must take seriously. Some of the above measures may seem drastic. Given the potential for patient death, drastic is often required.

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