1.2 INTENDED USE
The A.T.S. 3000 Tourniquet System is intended to be used by
qualified medical professionals to temporarily occlude blood
flow in a patient’s extremities during surgical procedures
on those extremities. Tourniquets have been found useful in
producing a bloodless operation field in surgical procedures
involving the extremities including:
Reduction of certain fractures
Kirschner wire removal
Tumor and cyst excisions
Total wrist joint replacement
Replacement of joints in the fingers
Knee joint replacements
WARNING: Do not use tourniquet cuffs to control the
distal flow of CO
or any other gases used as a distention
media. Tourniquet cuffs have not been evaluated for safety or
effectiveness in controlling gas flow beyond the surgical site
during arthroscopic insufflation procedures. Possible effects
of using a tourniquet cuff in this manner include serious
subcutaneous emphysema proximal to the cuff.
The medical literature lists the following as possible
contraindications. However, in every case, the final
decision whether to use a tourniquet rests with the
Open fractures of the leg
Post-traumatic lengthy hand reconstruction
Severe crushing injuries
Elbow surgery (where there is excess swelling)
Skin grafts in which all bleeding points must be
Compromised vascular circulation, e.g., peripheral
The presence of sickle cell disease is a relative
contraindication. (See PRECAUTIONS IN USE.)
A tourniquet should also be avoided in patients who
are undergoing secondary or delayed procedures
1.4 PRECAUTIONS IN USE
◆ The tourniquet system must be kept well calibrated
and in operable condition. Accessories should be checked
regularly for leaks and other defects.
◆ The tourniquet cuff must never be punctured; therefore
towel clips used near the system must be handled with
special care. Cuffs with inner rubber bladders must be
completely enclosed by the outer envelope to preclude
ballooning and possible rupture of the bladder. Cleaning and
assembly instructions of the cuff manufacturer should be
◆ Do not use an elastic bandage for exsanguination in
cases where this will cause bacteria, exotoxins, or malignant
cells to spread to the general circulation, or where it could
dislodge thromboemboli that may have formed in the vessels.
◆ The tourniquet cuff must be applied in the proper
location on the limb, for a “safe” period of time, and within
an appropriate pressure range. Never apply a tourniquet
over the area of the peroneal nerve or over the knee or
ankle. Do not readjust an already inflated cuff by rotating it
because this produces shearing forces which may damage the
◆ Prolonged ischemia may lead to temporary or permanent
damage to tissues, blood vessels, and nerves. Tourniquet
paralysis may result from excessive pressure. Insufficient
pressure may result in passive congestion of the limb with
possible irreversible functional loss. Prolonged tourniquet
time can also produce changes in the coagulability of the
blood with increased clotting time.
◆ Inflation should be done rapidly to occlude arteries and
veins as near simultaneously as possible.
◆ Careful and complete exsanguination reportedly
prolongs pain free tourniquet time and improves the quality
of Intravenous Regional Anesthesia, (Bier Block anesthesia).
In the presence of infection and painful fractures, after
the patient has been in a cast, and in amputations because
of malignant tumors, exsanguination before tourniquet
application may be done without the use of an elastic
bandage by elevating the limb for 3 to 5 minutes.
◆ In case of failure, the tourniquet cuff must be fully
deflated and the limb exsanguinated again before reinflation.
Reinflation over blood-filled vasculature may lead to
◆ Tourniquet users must be familiar with the inflation-
deflation sequence when using a dual-cuff tourniquet or two
tourniquet cuffs together for IVRA (Bier Block anesthesia),
so that the wrong tourniquet will not be released accidentally.
◆ Test for hemoglobin type and level before using a
tourniquet on patients with sickle-cell anemia. When the
tourniquet is used for these patients, the limb should be
carefully exsanguinated and the PO2 and pH should be
◆ Select the proper cuff size to allow for an overlap of
about 3 to 6 in. (7.6–15 cm). Too much overlap may cause
cuff rolling and telescoping, and may lead to undesired
pressure distribution on the limb. The skin under the
tourniquet cuff must be protected from mechanical injury by
smooth, wrinkle-free application of the cuff.
If the tourniquet cuff is applied over any material that
may shed loose fibers (such as Webril) the fibers may
become embedded in the contact closures and reduce their
effectiveness. As an under padding, a section of stockinette
may be used. The deflated cuff and any underlying
bandage or protective sleeve should be completely
removed as soon as tourniquet pressure is released.
After the cuff has been fully deflated and removed from
the patient, the unit can be set to STANDBY. Even the
slightest impedance of venous return may lead to congestion
and pooling of blood in the operative field.
◆ If skin preparations are used preoperatively, they should
not be allowed to flow and collect under the cuff where they
may cause chemical burns.
◆ Whenever the tourniquet cuff pressure is released, the
wound should be protected from blood surging back by
applying pressure dressings and, if necessary, elevating the
limb. Transient pain upon tourniquet pressure release can be
lessened by elevation of the limb. If full color does not return
within 3 to 4 minutes after release, the limb should be placed
in a position slightly below body level.
◆ Whenever IVRA, Bier Block anesthesia, is used, it is
recommended that the tourniquet remain inflated for at least
20 minutes from the time of injection.
◆ WARNING: Cuffs will not deflate in STANDBY
mode. Ensure cuffs are fully deflated before setting the
unit to STANDBY.
1.5 ADVERSE EFFECTS
A dull aching pain (tourniquet pain) may develop throughout
the limb following use.
hypercarbia, and acidosis of the tissues occur and become
significant after about 1 1/2 hours of tourniquet use.
Symptoms of tourniquet paralysis are motor paralysis
and loss of sense of touch, pressure, and proprioceptive
Intraoperative bleeding may be caused:
Pathophysiologic changes due to pressure, hypoxia,
By the slight impeding effect exerted by an
unpressurized cuff (and its padding, if used),
which prevents venous return at the beginning of
By blood remaining in the limb because of
By inadequate tourniquet pressure (between systolic
and diastolic blood pressure of the patient), or slow
inflation and deflation, all of which allow arterial
blood to enter while preventing venous return.
By blood entering through the nutrient vessels of the
long bones, such as the humerous.