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GENERAL INFORMATION
PRECAUTIONS IN USE
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Not for use in an oxygen rich environment with an oxygen concentration greater than 25% for ambient pressures
up to 110 kPa or the partial pressure of oxygen is greater than 27.5 kPa at ambient pressures exceeding 110 kPa.
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Normal operation has the
A.T.S.
4000TS running on ~ AC Power Mains via its power cord. The backup battery is
intended for emergency power or transport.
•
The Tourniquet system must be kept well calibrated and in operable condition. Accessories should be checked
regularly for leaks and other defects.
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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 followed carefully.
•
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.
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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 infl ated cuff by rotating it because this produces shearing forces which may
damage the underlying tissue.
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Prolonged ischemia may lead to temporary or permanent damage to tissues, blood vessels, and nerves.
Tourniquet paralysis may result from excessive pressure. Insuffi cient 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.
•
Infl ation should be done rapidly to occlude arteries and veins as near simultaneously as possible.
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Careful and complete exsanguination reportedly prolongs pain free Tourniquet time and improves the quality
of Intravenous Regional Anesthesia (IVRA), also known as 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 defl ated and the limb exsanguinated again before reinfl ation.
Reinfl ation over blood-fi lled vasculature may lead to intravascular thrombosis.
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Tourniquet users must be familiar with the infl ation-defl ation 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.
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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 PO
2
and pH should be
closely monitored.
•
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 fi bers (such as Webril) the fi bers may become embedded in the
contact closures and reduce their effectiveness. As an under padding, a section of stockinette may be used.
The
defl ated 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 defl ated 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 fi eld.
•
If skin preparations are used preoperatively, they should not be allowed to fl ow and collect under the cuff where
they may cause chemical burns.