Safe tourniquet use: a review of the evidence

Due in part to an emphasis on quality and cost control within healthcare institutions, protocols for healthcare practice are increasingly being developed in an effort to maintain normative guidelines and set acceptable standards. For example, the Association of periOperative Registered Nurses, the National Quality Forum, and the Association of Surgical Technologists have made recommendations regarding tourniquet use. In the institution of the senior authors (C.D. and E.A.), an effort to establish a protocol for tourniquet use prompted a review of the evidence behind standard practices and existing recommendations for safe tourniquet use in the upper and lower extremities. Sparse evidence exists in support of strict limits for tourniquet use, including tourniquet duration, inflation pressure, and reperfusion periods. However, simple principles and general guidelines regarding tourniquet use can be extrapolated to guide safe practice.