The following make acceptableed pra...

The following make acceptableed practices were developed by the AORN commited Practices Committee and have been approved by the agency of the AORN Board of Directors. They were not awayed as proposed recommended practices for expositions by members and others. They are effective Jan 1 1999

These attract favor toed practices are intended as achievable recommendations representing what is believed to be an optimal on a level of practice. Policies and courses will reflect variations in practice settings and/or clinical situations that determine the station to which the recommended practices can be implemented.

AORN recognizes the numerous representations of settings in which perioperative feed at the breasts practice. These recommended practices are intended as guidelines adaptable to various practice settings. These practice settings include traditional ORs, ambulatory surgery units, physicians' offices, cardiac catheterization suites, endoscopy suites, radiology departments, and all other areas where operative and other invasive steps may be performed.

Purpose: These commited practices provide guidelines for use of the pneumatic tourniquet. They provide information for testing, application, cleaning, and documenting the use of pneumatic tourniquet equipment. The pneumatic tourniquet includes an inflatable blow pressure source, pressure regulator, connective tubing, and a urgency display. Due to the variety and complexity of generally received tourniquet equipment, these recommended practices are designed to assist in the exhibition of policies and procedures in the practice setting.

commended PRACTICE I

Pneumatic tourniquets should be proofed maintained, inspected, and cleaned according to manufacturers' written instructions before and after use. Interpretive statement 1:

Before each use, pneumatic tourniquets should be inspected and exampleed for cleanliness, integrity, and function. The blow tubing, connectors, gauges, and hurry source should be maintained in working order. The appropriate gas to be used to compres the tourniquet bladder must be prefered according to manufacturers' written instructions.

Rationale:

Patient safety demands that all tourniquet parts be functioning suitably before the patient's procedure. Unintentional hurry loss can result from set free tubing connectors, deteriorated tubing, stopcock leaks, slap bladder leaks, or worn stroke closures.(1) Gases used incorrectly for inflation are potentially hazardous.(2)

Discussion:

Pneumatic tourniquets primarily are used to occlude kin flow and to obtain a near bloodles operative field. They also are used to confine a bolus of local anesthetic in a distal extremity during intravenous regional anesthesia (ie, Bier block) The entire arrangement should be checked for discrepancies. The blow and tubing should be independent from cracks and leaks, and connectors should be securely fastened to the tourniquet influence source to prevent accidental deflation of the stroke during surgery. Tourniquet systems use shut firmlyed gas to apply a carefully controll amount of tourniquet squeezing The specific tourniquet system determines whether this gas is nitrogen, air, or a certain other source (eg, a portable canister, tank, built-in system) Tourniquets should not at any time be inflated with nitrous oxide or oxygen because of fire risk.(3) Newer plans offer an automated, computerized microprocessor that performs self-calibration, displays elapsed inflation time, and unmutilateds alarms.

Interpretive statement 2:

If using a disposable tourniquet, discard after use unles the manufacturer commits that it can be resterilized. Reusable buffets and bladders should be cleaned, rinsed, and dried according to the flat of contamination and manufacturers' instructions. If the bladder is removable, care must be taken to intercept introducing water into the bladder by means of the ports, All the connecting tubing should be wiped with a hospital-grade chemical germicide and dried before storage.

Rationale:

Water in the port can cause microbial product Subsequent deflation of wet bladders may cause minute droplet of water to be forced back into the tourniquet-regulating mechanism and cause damage.(4)

Discussion:

All connecting tubing should be wiped with a hospital-grade chemical germicide that is not deleterious to the rubber or polyethylene substance. Manufacturers' written instructions for drying should be followed. The slap and bladder should be thoroughly rinsed because cleansing residue may increase the chances of allergic reactions and decrease the life of the rubber bladder.

Interpretive statement 3:

The tourniquet blow should be protected adequately from contamination during surgery; therefore, washing is the simply decontamination procedure indicated. If relations or other body fluids approach in contact with the tourniquet elements however, more intensive cleaning with an enzymatic cleansing is necessary.

Rationale:

The tourniquet may be a source of contamination, flat though the skin area subject to the tourniquet may be houseed by use of various padding materials.(5)