Know How to Improvise a Tourniquet

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Specializes in being a Credible Source.

One of the things that I like about ED nursing is the unknown that's always right around the corner and the zero-to-sixty rush...

We had an upper extremity arterial bleed walk into the lobby... greeter got some pressure on the pumper and got him STAT to the trauma bay. The docs say, "we need a tourniquet on him, now!" A couple nurses, including me, say "we don't have those" - referring to those slick CAT tourniquets (like I keep in my home medical kit)... the order gets repeated several times and we have this room full of people all standing there sort of looking at each other.

Finally, I grab a roll of kerlix and a yankaur and make a very effective tourniquet... patient gets packaged (now complaining of the pain of the tourniquet rather than the repeated expressions of fear for his life) and straight to the OR.

Lesson to all of my ED colleagues... a tourniquet is one of those things that you rarely need but, when you need one, you need it right now.

So, if you don't stock CATs, take a few minutes to figure out how to make a tourniquet... not just in theory (which is exceedingly simple) but in actuality, with what you actually have at hand.

In my case, the kerlix was obvious... then I'm standing there looking around thinking, "what to use as a windlass?" Things that ran through my head...

  • 12-cc syringe (too short, too slipery)...
  • bite stick (too short... probably too flimsy)... .
  • trauma shears (didn't have mine in my pocket and figured the handle might break off)...
  • vacutainer tubes (hey, I was brainstorming in the midst of an arterial bleed... at least I recognized the immediate stupidity of the idea)
  • Bougie... (um... see, vacutainer)
  • Then, I see the yankaur staged on the sxn cannister... nice and long... grab it, nice and rigid... nicely shaped... BINGO.

Ten seconds later, hemostasis...

Obviously, the time for me to have considered how to fab a tourniquet would have been BEFORE the arterial bleed was squirting but I came through in a pinch.

So... to all who read these words... figure it out now, not when you actually need it.

And for heaven sake, ED managers... stock some stinking CATs!

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Specializes in NICU.

We used to use a B/P cuff for an upper extremity arterial bleed in EMS..very effective.

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Specializes in Emergency Department.

That's not only good thinking, it's also cheap thinking as what you came up with is probably much less expensive than the CAT. A roll of Kerlix and a yankauer suction catheter definitely gets the job done quickly (perhaps not quite as quickly as a CAT does) and effectively without much fuss. What you came up with is also very much disposable! When they're ready to release the TK, they can either unwind it or they can simply cut it off.

Awesome work!

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Nice thinking. I would probably just tie a sheet or towel, wouldn't think of the windlass. Now I know. I've never actually seen a tourniquet like one by medics in the field.

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We used to use a B/P cuff for an upper extremity arterial bleed in EMS..very effective.
Yeah, if you've got one big enough... which we didn't... that's what they were trying but without much success... turns out our monitors won't attain and hold high pressures and the bedside manual one wasn't big enough...

And neither would've been portable to take to the OR...

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Nice thinking. I would probably just tie a sheet or towel wouldn't think of the windlass. Now I know. I've never actually seen a tourniquet like one by medics in the field.[/quote']Without the windlass, it's pretty tough to attain *and* hold enough pressure.

And sheets and towels are very bulky... probably need to be cut down to be effective... and our towels aren't really long enough (18" to 24" or so...)

The first thing in my mind was my Boy Scout first aid merit badge (in 1976...) where we learnt to do them with triangular dressings and sticks.

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Specializes in Emergency.

I've used a BP cuff the two times I've needed them. Manual cuffs work great for arms or legs.

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Specializes in ICU.

Apply direct pressure to the artery above the bleed at the chest

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Specializes in Emergency Nursing.
I've used a BP cuff the two times I've needed them. Manual cuffs work great for arms or legs.

That is what I have used too.

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Specializes in ED.

We use a manual BP cuff and inflate to 30-60 points above the systolic value.

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The cuffs don't work on proximal bleeds...smart thinking with the kerlix! For a while there were counterfeit/poorly made CATs out there...so make sure there is a red semicircle at the end of the velcro on yours. SOF tourniquets require a little bit more training, but their steel windless will not break...ever. We always prepped a second CAT in case when you were cranking down one someones thigh, the CAT snapped.

I don't know how common Combat Gauze is in civilian EDs, but for inguinal and axially bleeders, it is the bomb! Just pack and press.

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I'm not an ED nurse, so humor me please. Why would a disposable rubber tourniquet (such as used for IV starts), applied tightly, not work in this case?

ETA: is it because the wound itself needs to be occluded?

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