Know How to Improvise a Tourniquet

[Music in My Heart]

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!

[504 medic]

Sounds much too messy for me. I'll improvise the tourniquet but I'm not climbing up on top of a patient with an arterial bleed.

If you're in a hospital environment, where you can replace the RBCs immediately, no worries...but if not: take the patient down to the ground, stick you knee deep in their inguinal/axillary region, put ALL your weight on it, occlude their artery, and affix your tourniquet. 2 minutes of unabated blood loss, while you create an effective improvised tourniquet out of thin air, will leave them way too deep in hypovolemia-landia for my liking.

[ready2g0]

If you do use a manual BP cuff, make sure you re-inflate it frequently enough because it will start to deflate.

If you're in a hospital environment, where you can replace the RBCs immediately, no worries...but if not: take the patient down to the ground, stick you knee deep in their inguinal/axillary region, put ALL your weight on it, occlude their artery, and affix your tourniquet. 2 minutes of unabated blood loss, while you create an effective improvised tourniquet out of thin air, will leave them way too deep in hypovolemia-landia for my liking.

Yeah, if you're willing to kneel in the patient's blood... I'm not...

[Esme12, ASN, BSN, RN]

Yeah if you're willing to kneel in the patient's blood... I'm not...[/quote']I'm with you..I have done some creative things like that in the field...or directed someone else to ...but in the facility...uhm...no.

I have used my trauma shears to cut a pillow case in a strip and used a straight blade to tighten...it works.

[SgtWyatt]

I know this is kind of an old thread by now but I wanted to share my experience in the ED the other night. Had a patient brought in by ambulance from a dialysis center for a bleeding AV fistula (forearm placement). There was a gauze pressure dressing in place which had been put on by the dialysis center and the bleeding seemed well controlled (gauze was pretty clean). Our doc went back to take a look and unwrapped the dressing and when she did the patient began hemorrhaging! One of the nurses ran up to me and said that they needed help with an arterial bleed and when I went back with him the patient must have already lost nearly a liter of blood. Direct pressure was being applied but the blood was still pouring and nobody could find a manual BP cuff. We were trying to find something to use to make a tourniquet when our ER tech ran in with his personal BP cuff which he kept in his car. We pumped it up all the way and the bleeding stopped to a trickle, allowing the doc to suture the bleeder.

Prior to the bleed the patient's systolic BP was in the 160s, afterward it was in the mid 90s! Patient was stabilized, was admitted and I think received 4 units of blood.

Right after that I ordered two CATs on Amazon: one as a gift to the department and the other to keep in my car's jump bag!

Hadn't thought about the kerlix + yankour idea, but thanks for sharing. I'm definitely going to practice rigging something up on my next shift and then show the other nurses how to do it in a pinch!