Distal Tourniquet-Facilitated Radial Arterial Cannulation in Adults—a Double-Blinded, Prospective, Randomized and Controlled Study
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Purpose Relatively small radial artery may be challenging for cannulation. We investigated whether a distal tourniquet would inflate the proximal radial artery and therefore facilitate cannulation in adults. Methods There were two stages of the study. The first was to measure the characteristics of radial artery by ultrasound imaging before and after tourniquet in volunteers. The second was a prospective, randomized, double blind study. Forty patients (American Society of Anesthesiologists I-III) who needed artery cannulation during operation were enrolled. Patients were assigned into two groups: loosen or tightened tourniquet for proximal radial artery cannulation by traditional palpation technique. The primary endpoints were the success rates and time of first attempt success by traditional palpation technique. The time of success after two to three attempts, failure rates and complications were collected. Results For volunteers, the distal tourniquet significantly expanded the cross-sectional up-forward diameter (p<0.001) and the area (p<0.05), but had no effect on cross-sectional lateral-lateral diameter or circumference of proximal radial artery (p>0.05). The success rate of first attempt was higher in the tighten group (75%) than in the loosen group (15%, p<0.05), but the time for success of first attempt/two to three attempts was similar (19.33 ± 1.12/62.11 ± 37.03 sec loosen group vs. 19.07 ± 12.75/45.55 ± 8.98 sec tightened group, p>0.05). Both groups had same failure rates of 10%. No complication was observed. Conclusions Distal tourniquet could inflate the proximal radial artery and facilitate palpation of radial artery cannulation.Keywords:
Double blinded
Battlefield
Confusion
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Local hypothermia was studied as a method to safely prolong tourniquet time for reconstructive procedures of the upper extremity. An ice blanket constructed of flannel cloth and cold gel packs was applied to the limb for 45 minutes preoperatively. Seventy-eight patients were evaluated for complications resulting from hypothermia and prolonged tourniquet application. The duration of continuous tourniquet ischemia averaged two hours and 25 minutes. Intraoperative muscle temperature recordings indicated that the iced limbs were an average of 12.9 degrees cooler than noniced limbs before tourniquet inflation. Electron microscopic studies of biopsied muscle showed no evidence of ischemic changes. There were no postoperative complications associated with prolonged tourniquet inflation or the hypothermia blanket technique. Local hypothermia appears to be a safe and effective method of decreasing the adverse effects of tourniquet ischemia and allowing continuous tourniquet inflation time to extend safely beyond the customary two-hour limit.
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• Post-tourniquet syndrome is a common reaction to prolonged ischemia. • The prolonged placement of the tourniquet causes the tissue ischemia and necrosis. • Intelligent tourniquet can prevent the complications of prolonged placement of tourniquet.
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The tourniquet pain during 30 minutes after the application of calf tourniquet and ankle tourniquet were assessed and compared in 63 healthy volunteers, 32 males and 31 females whose ages ranged from 21-36 (average, 24) years. The visual analogue pain score assessed at 0, 1, 3, 5, 10, 20, 30 minutes of adequate tourniquet pressure application and after removal of the tourniquet at 0, 5 and 30 minutes were recorded. The results revealed significant less visual analogue pain scores with the ankle tourniquet group (range, 0-4.4 mmHg) than the calf tourniquet group (range, 0-6.7 mmHg) at all time-points of evaluations and the tourniquet pain was also diminished faster in the ankle tourniquet group after the tourniquet was removed. It was also found a significant higher minimal tourniquet pressure required for the vascular occlusion distal to the tourniquet sites detected by a pulse oximeter in the ankle tourniquet group (mean, 310.8 +/- 40.8 mmHg) than the calf tourniquet group (mean, 272.5 +/- 36.9 mmHg, p = 0.024). The present study supports the use of ankle tourniquet to minimize tourniquet pain for foot surgery.
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We sought new knowledge by further developing a model of using calculations in the simulation of a first-aid task. The purpose of this study was to develop the model to investigate the performance of tourniquet use in its component steps.We aimed to design an experiment on a desktop computer by mathematically manipulating simulated data in tourniquet use. A time factor of tourniquet use was ranged widely through time challenges in five degrees from ideal to worst performances. Redesigning the task was assessed by time costs and blood losses.The step of tourniquet application took 17% of the trial time and securing the tourniquet after bleeding control took the longest amount of the trial time, 31%. A minority of the time (48% [17% + 31%] to apply tourniquet plus secure it) was spent after the tourniquet touched the patient, whereas most of the time (52%) was spent before the tourniquet touched the patient. The step of tourniquet application lost 14% of the total blood lost, whereas no blood was lost during securing the tourniquet, because that was the moment of bleeding control despite securing the tourniquet taking much time (31%). Most (86%) of blood lost occurred before the tourniquet touched the patient. But blood losses differed 10-fold, with a maximum of 2,434mL, which, when added to a pretask indication blood loss of 177mL, summed to 2,611mL. Before redesigning the task, costs of donning gloves and calling 9-1-1 included uncontrolled bleeding, but gloving mitigated risk of spreading pathogens among people. By step and person, redesigns of the task altered the risk-benefit profile.The model was useful because it simulated where most of the bleeding occurred before the tourniquet touched the patient. Modeling simulated redesigns of the task, which showed changes in the task's risk-benefit profile by step and among persons. The model generated hypotheses for future research, including the capability to screen candidate ideas among task designs.
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This investigation examined the effect of three factors--tourniquet width, tourniquet inflation pressure, and application of the tourniquet to the left or right extremity--on the intensity of tourniquet pain and duration of tourniquet inflation, as well as the circulatory effects associated with maintenance of inflation of a pneumatic tourniquet on an upper extremity of 12 healthy, unmedicated volunteers. All subjects manifested a time-dependent circulatory response to maintenance of tourniquet inflation, characterized by increases in heart rate and systolic and diastolic blood pressure. The mean duration of tourniquet inflation was 34 +/- 13 minutes (mean +/- SD). No difference was demonstrated with respect to the width of the tourniquet, the tourniquet inflation pressure, or the application of the tourniquet to the left or right extremity on the intensity of pain or the duration of tourniquet inflation.
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Radial endothelial dysfunction may occur after transradial coronary angiography (CAG). This study aimed to make a comparative evaluation of the radial endothelial functions before and after catheterization between three different radial access sites: left radial (LR) artery, left distal radial (LDR) artery, and right radial (RR) artery.Seventy patients scheduled for elective transradial CAG and intervention from September 6, 2017 to March 6, 2018 were consecutively enrolled. Radial artery endothelial functions of the catheterization arm were measured by flow-mediated vasodilation (FMD) upon admission, at 24 hours, and 2 months following the procedure.LR access was used in 17 patients, whereas the LDR and the RR access were used in 27 and 26 patients, respectively. Basal radial diameters and FMD median values measured on the intervention arm were found to be similar between groups (LR 3.04±0.29 mm, 13.33%; LDR 2.79±0.31 mm; 13.64%; RR 2.74±0.29 mm; 12.52%, p=0.952). The radial vasodilation percentage change expressed as median decreased in all groups 24 hours after the procedure; however, the one with the LDR access was found to be significantly higher than with the LR (9.7% vs. 6.25% p=0.013) and the RR access (9.7% vs. 3.39 p<0.001). A partial recovery of endothelial functions was seen at 2 months after the procedure, approximating to basal values (11.11%; 12%; 10.62%, p=0.079, respectively).Radial artery functions deteriorate early after transradial catheterization. The LDR access seems safer than the other conventional radial access sites in terms of preservation of radial endothelial functions.
Cardiac catheterization
Basal (medicine)
Radial stress
Endothelial Dysfunction
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The modern arterial tourniquet is an automatic tourniquet system which contains many features that help to minimise complications and improve safety. However, the non-pneumatic tourniquet is still in use, a practice that may be commoner in resource-constrained settings. This study was conducted to investigate the types of tourniquet available and used by orthopaedic surgeons in Nigeria as well as the practical aspects and complications of their use of the tourniquet.At an Annual General Meeting/Scientific Conference of Nigerian Orthopaedic Association, a survey was conducted among orthopaedic surgeons using a pre-tested self-administered questionnaire which contained questions on types of tourniquet, practical aspects of the use of tourniquet and complications.The non-pneumatic tourniquet was usually used by 60.2% of the respondents and 58.1% of those who had both pneumatic and non-pneumatic tourniquets used the latter more commonly. In most cases, the tourniquet was applied by surgeons or surgical residents on the arm or thigh. Surgeons who had ever used the tourniquet in diabetic patients were 71.6% while 29.5% had used it in patients with sickle cell disease. Tourniquet duration was usually 1½ h and 2 h in the upper and lower limbs, respectively. The two most common complications were tourniquet palsy and tourniquet pain.The non-pneumatic tourniquet was more commonly used than the pneumatic tourniquet. Application of the tourniquet on sites other than the thigh and the upper arm were uncommon. The most common complication was neurologic injury.
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This study investigated the infuluence of a tourniquet on anterior intracompartmental pressure of the lower leg. Thirteen patients who had arthroscopic surgery were measured with a Millar catheter transducer system. A tourniquet was applied in seven patients (tourniquet group) while six controls did not have a tourniquet applied (nontourniquet group). The tip of the Millar catheter was placed in the anterior tibial compartment. No statistically significant difference in age, blood pressure, and interval throughout the operation appeared when the tourniquet and non-tourniquet groups were compared. Immediate postoperative intracompartmental pressures in the tourniquet group were statistically significantly higher than that of the non-tourniquet group (p<0.03). The duration required for the intracompartmental pressure to recover to the normal level in the tourniquet group was statistically significantly longer than that of the non-tourniquet group (p<0.05). Results indicated that it is justified not to use a tourniquet during simple surgical procedures.
Tibialis anterior muscle
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