Have any of you ever left a tourniquet on a patient after an iv start?

SmilingBluEyes · Oct 25, 2015

No I have not. I always tie in a way that is not a knot or bow, but just folded over and I automatically "snap" it open when I am done sticking the vein.

I do want some background. I see you just joined the site and this is like your first or second post.

Why do you ask? Was it something you did and harm was done?

If so, be aware no one here can really give advice, legal advice, that is.

marie.rn2419, RN · Oct 25, 2015

I would hope that you have been trained prior to starting an IV on a patient. There is no excuse for leaving the tourniquet on. You should be sure to release the tourniquet as soon as possible after completing your IV insertion. To reduce your risk of error, document your procedure and removal of tourniquet only after completing it, double check the tourniquet has been removed before leaving patient's roomâ€¦

Basically, increase your awareness and be consistent in your routine completion of tasks.

Leaving a tourniquet on longer than necessary can cause circulatory, neurological, vascular and muscular damage. (e.g. redness, indentation, pain, discomfort, extremity edema, extremity temperature or color change [pale, blue, gray,purple, dusky], numbness/tingling/burning, skin tears, IV infiltrations, delayed cap refillâ€¦ I could go on)

It is important to report any discoveries/recollection of forgetting, because CBCs or K+ level draws can be altered if drawn from an extremity that has been subject to a prolonged period of time with a tourniquet on.

AnnieOaklyRN, BSN, RN, EMT-P · Oct 25, 2015

To the above poster, I have never worked in a hospital that makes you document tourniquet removal!

To the OP I have done it once and I won't do it again, the IV blew because the fluid was wide open and it had no place to go. It does happen all the time, especially if the jonny sleeve covers it.

It is a mistake, you are human, learn from it. And again to the above poster, their is an excuse, its called being human. You cannot say you are a nurse and have NEVER made a mistake!! OP don't beat yourself up about it, just learn from it if it happened to you, and move on.

A hospital in my area even switched to BRIGHT ORANGE tourniquets to decrease the chance of this happening. The worst that is going to happen is that the IV will infiltrate and the patient will of course have pain and discomfort, and more than likely someone is going to notice it long before anything serious would occur!

Annie

KatieMI, BSN, MSN, RN · Oct 25, 2015

Once I've got a patient transferred from a main med/surg floor with mention that he is "an extremely hard stick and so you better keep the iv we just managed.... blah, blah". The hospital had "rapid responce" team responsible for "hard sticks" and very soon floor nurses started to abuse that opportunity and, consequently, lost their IV skills, so i took it with a big grain of salt. The patient came with something being infused and the tourniquet above the iv still tied, apparently, for at least couple of hours. Hand was puffy but warm and with good pulses. I was surprised that the iv did not infiltrated, but just till the moment i looked closer, because it was obvious that it was staying in the artery instead of vein. We happened to have no policy covering such a situation, so we just did neurovascular checks on that extremity every hour for 12 hours and file incident report.

~PedsRN~, BSN, RN · Oct 25, 2015

Man, I would think that unless the patient is neurologically NOT intact - that they would complain about having a tourniquet tied on for any length of time. OUCH!

SleeepyRN · Oct 25, 2015

A hospital in my area even switched to BRIGHT ORANGE tourniquets to decrease the chance of this happening. The worst that is going to happen is that the IV will infiltrate and the patient will of course have pain and discomfort, and more than likely someone is going to notice it long before anything serious would occur!
Annie

The very fact that they changed colors to orange is proof that it happens more than we'd like to think it does.

xxMichelleJxx · Oct 25, 2015

I have not thankfully. Some tips: when inserting a IV or drawing blood, take the extra time to fully roll up your patient's sleeve. Ensure the area of where you will be applying the tourniquet is visible, as well as above. I also take a piece of tape and put it to my upper aspect of my forearm. It pretty much serves as a reminder. I get so paranoid because I don't ever want to forget a tourniquet. One of my old clinical instructors shared one of her experiences with us and it has caused me to be extra conscientious.

Mursechico · Oct 25, 2015

Thank you so much to all your replies! More info, I did an incident report, ER doc was called and told of incident. Patient is fine, just wanted some outlook, I know we all make mistakes.

applesxoranges, BSN, RN · Oct 25, 2015

Anyone ever left a tourniquet on a patient after starting an IV? If so what happened?

Probably. I don't remember. I've started a lot of IVs so the odds of leaving one on is fairly odd. Figure at least 8 a day as an RN and I was a paramedic before that where all I did was start IVs and draw blood so 20 a day minimum during that time period? Lots and lots.

I don't tie my tourniquet so tight that it really obstructs blood flow completely. It's not a trauma. You just need a little extra pressure and even then it may make the veins blow easier. I remember being shocked at how tight a student nurse was tying the tourniquet the other day.

JVoEDrn · Oct 25, 2015

Yes I have! Luckily I noticed quickly and nothing happened. It happens.

cayenne06, MSN, CNM · Oct 25, 2015

There is no excuse for leaving the tourniquet on.
Leaving a tourniquet on longer than necessary can cause circulatory, neurological, vascular and muscular damage. (e.g. redness, indentation, pain, discomfort, extremity edema, extremity temperature or color change [pale, blue, gray,purple, dusky], numbness/tingling/burning, skin tears, IV infiltrations, delayed cap refillâ€¦ I could go on)
It is important to report any discoveries/recollection of forgetting, because CBCs or K+ level draws can be altered if drawn from an extremity that has been subject to a prolonged period of time with a tourniquet on.

Well. Mistakes happen. There's no "excuse" needed. This particular error hasn't happened to me, but just like every other human being I make mistakes on the job every once in a while. Sounds like the OP did the right thing and learned from her mistake. That's why it's called the PRACTICE of nursing.

One time I gave vyvanse instead of vistaril (both were ordered for the patient, I was a flustered new nurse and did not do my "5 rights."

On one of my first shifts on the floor after being out of acute care for a number of years, I tried to insert an IV with the needle pointing distally. And the patients husband, sitting there watching me, was an EMT.

I once ran an entire g tube feed with the med port open. Just a few days ago I forgot to order a urine culture for a patient I suspected had pyelonephritis. Major mistake.

Need i go on? Im not ashamed of my mistakes, and i speak of them openly because i take responsibility for my errors and for taking steps to identify and remedy whatever caused me to make the mistake in the first place.

I still consider myself a damn good RN and CNM.