Zimmer A.T.S. 1200, Руководство оператора и сервисное руководство

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1.2 INTENDED USE
The A.T.S. 1200 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
Subcutaneous fasciotomy
Nerve injuries
Tendon repair
Bone grafts
Total wrist joint replacement
Replacement of joints in the fingers
Knee joint replacements
Amputations
Replantations
WARNING:
Do not use tourniquet cuffs to control the distal
flow of CO
2
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.
1.3 CONTRAINDICATIONS
The medical literature lists the following as possible
contraindications. However, in every case, the final decision
whether to use a tourniquet rests with the attending
physician.
Open fractures of the leg
Post-traumatic lengthy hand reconstruction
Severe crushing injuries
Elbow surgery (where there is excess swelling)
Severe hypertension
Skin grafts in which all bleeding points must be
readily distinguished
Compromised vascular circulation, e.g., peripheral
artery disease
Diabetes mellitus
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 after
immobilization.
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
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.
◆
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
underlying tissue.
◆
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
intravascular thrombosis.
◆
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 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 cm – 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
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A.T.S. 1200 TOURNIQUET SYSTEM