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From the Editor's Desk

Why do tourniquets and water pitchers need instructions?

by Dennis Ernst • February 08, 2019

Editor's Desk


Friends,

In our profession, we'd be lost without tourniquets. It's a simple device that costs mere pennies, but without them patient care comes to a screeching halt. Without tourniquets, we'd fail to draw blood on most of our patients, depriving physicians of critical data by which to diagnose, medicate and manage their patients. No tourniquet, no blood test.

Over the years, I've written plenty of columns and articles about tourniquets. They're an essential tool of the trade. You wouldn't think something as simple as a tourniquet would have many precautions, but it does. It requires its user to be well aware of a multitude of risks and precautions, any one of which, if neglected, can cause problems that range from mild discomfort to catastrophic consequences. For example:

  • They should be applied over clothing when possible to prevent the patient's skin from being pinched;
  • Leaving them on for more than one minute can significantly alter the blood in the limb before it's even drawn in ways that no longer represent the patient's health status;
  • Up to 25 percent of tourniquets are contaminated with MRSA after just one use;
  • Latex-sensitive patients can go into anaphylactic shock if a latex tourniquet is applied for phlebotomy;
  • Failure to use a tourniquet can lead to improper vein selection, which can precipitate an injury to nerves and arteries that lead to permanently disabling complications.

Given all that, why is it tourniquets do not come with manufacturer's instructions? I bought a plastic water pitcher not long ago that included a page of instructions that including these helpful tips *(click on image at right to enlarge):: "Fill with beverage and serve," "Do not overfill," and "Place on surface away from the edge to avoid drops and spills." Seriously, if a plastic pitcher needs instructions, wouldn't a tourniquet that constricts a patient's blood flow need some basic instructions for use?

Instead, it's up to those who train healthcare workers to articulate all that must be known about proper tourniquet use. If it were up to me, I'd not only include the precautions I listed above, but I'd add the following:

  • Do not launch across the room at coworkers;
  • Not to be used as a slingshot;
  • Not intended to be used with gauze as a substitute for a bandage;
  • Do not allow patients or their children to play with the tourniquet;
  • Using two tourniquets does not double the constriction;
  • Do not apply one tourniquet at the wrist and one above the elbow.
  • Do not use for months on end;
  • Do not eat.

Okay, I might be getting a little silly here, so let's get serious. There's one more precaution that we have to discuss: forgetting to remove the tourniquet . Forgotten tourniquets are a major risk in healthcare. When inadvertently left behind, the continuous constriction of the limb can lead to serious complications including nerve injury, tissue necrosis, deep-vein thrombosis, embolism, compartment syndrome, amputation and death.

In 2017, the California Hospital Patient Safety Organization (CHPSO) issued a report citing the complications of forgotten tourniquets and preventative measures. One of them is the use of brightly colored tourniquets that are extra long to enhance visibility. In the June 2018 issue of Phlebotomy Today, I extrapolated from published data that healthcare professionals forget tourniquets on nearly 3,000 patients every year.

Now we have one more weapon in our arsenal against the forgotten tourniquet. Recently our friends at MarketLab designed a sticker phlebotomists and other healthcare professionals can place on a patient's clothing prior to the draw that serves as a visible reminder a tourniquet is in place. Printed in highly visible caution-yellow, the label reads "Forgetting Something?" and includes instructions to the patient should the sticker also be left behind.

Sometimes the simplest solutions are the best. Given the magnitude of the consequences that can come from leaving a tourniquet in place, applying this simple reminder to an inpatient's gown or outpatient's clothing is a simple, cheap, and effective risk management tool. Not only can this help ensure phlebotomists retrieve their tourniquet before leaving the patient, but if every sticker is removed before leaving the patient and then counted upon arrival back in the laboratory, the number of stickers retrieved should equal the number of patients drawn. If not, returning to every patient for a tourniquet check can prevent an incident from becoming a serious problem.

Unlike tourniquets and plastic pitchers, MarketLab's tourniquet reminder doesn't require instructions for use. Simply apply it before the draw and remove it after; simple as that.

Just don't eat it.

Respectfully,

Dennis


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blood draw constriction MRSA phlebotomist professionalism tourniquet


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