The patient must be positively identified when the blood specimen is collected. Identification of the patient is crucial to ensuring that the blood specimen is drawn for the correct patient.
The likelihood of error occurring in the area of collecting and handling specimens is probably greater than the likelihood of error occurring in the procedure itself. Much attention needs to be devoted to the process of collecting and handling specimens.
Assemble the necessary supplies for the Vacutainer®. The evacuated tube system is the most commonly used means of collecting specimens. This system is preferable to the needle and syringe since it allows the blood to pass directly from the vein to the evacuated tube. The evacuated tube system decreases the possibility of needlesticks, helps to eliminated some labelling errors and decreases the likelihood of inappropriate specimens.
It is important to not leave the tourniquet on for longer than one minute; to do so may result in either hemoconcentration or variation in blood test values.
For accurate test results, follow the proper Vacutainer® draw order. The following is an example of the most common draw order:
- Blue (citrate tube)
- Red
- SST (serum separator tube)
- Green (heparin)
- Lavender (EDTA)
- Grey (sodium fluoride)
Also, to eliminate tissue fluid contamination, it is suggested that 3 to 4cc of blood be drawn into sodium citrate tubes (blue) before filling sodium citrate tubes (blue).
Some tests require that blood specimens be cooled in ice water, placed in warm water, or protected from light immediately following the venipuncture in order to prevent metabolic processes which may cause alteration of some test values. Specimen handling instructions are included in the test list in this manual.
Use "universal precautions" at all times.
WITHOUT capping needles, dispose of the puncture unit in an appropriate Sharpes container. Bag each specimen as required by Infection Control policies and place in laboratory courier box at the nursing station.
1. Murphy CG, Winter DC, Bouchier-Hayes DJ. Tourniquet injuries: Pathogenesis and modalities for attenuation. Acta Orthop Belg. 2005;71:635–45. [PubMed] [Google Scholar]
2. Deloughry JL, Griffiths R. Arterial tourniquets. Contin Educ Anaesth Crit Care Pain. 2009;9:56–60. [Google Scholar]
3. McEwen JA. Tourniquet use. [Last accessed on 2014 Jun-Jul]. Available from: //www.tourniquets.org/lop.php .
4. Recommended Practices for the Use of the Pneumatic Tourniquet in the Perioperative Practice Setting. AORN Guidelines on Use of Pneumatic Tourniquets. 2009:373–85. [Google Scholar]
5. Maury AC, Roy WS. A prospective, randomized, controlled trial of forearm versus upper arm tourniquet tolerance. J Hand Surg Br. 2002;27:359–60. [PubMed] [Google Scholar]
6. Odinsson A, Finsen V. The position of the tourniquet on the upper limb. J Bone Joint Surg Br. 2002;84:202–4. [PubMed] [Google Scholar]
7. Tuncali B, Karci A, Bacakoglu AK, Tuncali BE, Ekin A. Controlled hypotension and minimal inflation pressure: A new approach for pneumatic tourniquet application in upper limb surgery. Anesth Analg. 2003;97:1529–32. [PubMed] [Google Scholar]
8. Dreyfuss UY, Smith RJ. Sensory changes with prolonged double-cuff tourniquet time in hand surgery. J Hand Surg Am. 1988;13:736–40. [PubMed] [Google Scholar]
9. Noordin S, McEwen JA, Kragh JF, Jr, Eisen A, Masri BA. Surgical tourniquets in orthopaedics. J Bone Joint Surg Am. 2009;91:2958–67. [PubMed] [Google Scholar]
10. Oragui E, Parsons A, White T, Longo UG, Khan WS. Tourniquet use in upper limb surgery. Hand. 2011;6:165–73. [PMC free article] [PubMed] [Google Scholar]
11. Sato J, Ishii Y, Noguchi H, Takeda M. Safety and efficacy of a new tourniquet system. BMC Surg. 2012;12:17. [PMC free article] [PubMed] [Google Scholar]
12. Ishii Y, Noguchi H, Matsuda Y, Takeda M, Higashihara T. A new tourniquet system that determines pressures in synchrony with systolic blood pressure. Arch Orthop Trauma Surg. 2008;128:297–300. [PubMed] [Google Scholar]
13. Tuncali B, Karci A, Tuncali BE, Mavioglu O, Ozkan M, Bacakoglu AK, et al. A new method for estimating arterial occlusion pressure in optimizing pneumatic tourniquet inflation pressure. Anesth Analg. 2006;102:1752–7. [PubMed] [Google Scholar]
14. Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2013. Recommended practices for care of patients undergoing pneumatic tourniquet-assisted procedures; pp. e25–e50. [Google Scholar]
15. Guay J. Adverse events associated with intravenous regional anesthesia (Bier block): A systematic review of complications. J Clin Anesth. 2009;21:585–94. [PubMed] [Google Scholar]
16. Hicks RW, Denholm B. Implementing AORN recommended practices for care of patients undergoing pneumatic tourniquet-assisted procedures. AORN J. 2013;98:383–93. [PubMed] [Google Scholar]
17. Wilson M, Forsyth P, Whiteside J. Haemoglobinopathy and sickle cell disease. Contin Educ Anaesth Crit Care Pain Oxford J. 2010;10:24–8. [Google Scholar]
18. Fitzgibbons PG, Digiovanni C, Hares S, Akelman E. Safe tourniquet use: A review of the evidence. J Am Acad Orthop Surg. 2012;20:310–9. [PubMed] [Google Scholar]
19. Standards, Guidelines, and Position Statements for Perioperative Registered Nursing Practice ORNAC Safety/Risk Prevention and Management. 2011 Mar [Google Scholar]
20. Sharma JP, Salhotra R. Tourniquets in orthopedic surgery. Indian J Orthop. 2012;46:377–83. [PMC free article] [PubMed] [Google Scholar]
21. Mingo-Robinet J, Castañeda-Cabrero C, Alvarez V, León Alonso-Cortés JM, Monge-Casares E. Tourniquet-related iatrogenic femoral nerve palsy after knee surgery: Case report and review of the literature. Case Rep Orthop. 2013;2013:368290. [PMC free article] [PubMed] [Google Scholar]
22. Van der Spuy LA. Complications of the arterial tourniquet. South Afr J Anaesth Analg. 2012;18:14–8. [Google Scholar]
23. Shadgan B, Reid WD, Harris RL, Jafari S, Powers SK, O'Brien PJ. Hemodynamic and oxidative mechanisms of tourniquet-induced muscle injury: Near-infrared spectroscopy for the orthopedics setting. J Biomed Opt. 2012;17:081408–1. [PubMed] [Google Scholar]
24. Estebe JP, Davies JM, Richebe P. The pneumatic tourniquet: Mechanical, ischaemia-reperfusion and systemic effects. Eur J Anaesthesiol. 2011;28:404–11. [PubMed] [Google Scholar]
25. Zaman SM, Islam MM, Chowdhury KK, Rickta D, Ireen ST, Choudhury MR, et al. Haemodynamic and end tidal CO2 changes state after inflation and deflation of pneumatic tourniquet on extremities. Mymensingh Med J. 2010;19:524–8. [PubMed] [Google Scholar]
26. Feng L, Zhang XG, Yang QG, Wang G. Effects of tourniquet on cardiac function in total knee arthroplasty with trans-esophageal echocardiography. Zhonghua Yi Xue Za Zhi. 2013;93:3755–7. [PubMed] [Google Scholar]
27. Saied A, Ayatollahi Mousavi A, Arabnejad F, Ahmadzadeh Heshmati A. Tourniquet in surgery of the limbs: A review of history, types and complications. Iran Red Crescent Med J. 2015;17:e9588. [PMC free article] [PubMed] [Google Scholar]
28. Allee J, Muzaffar AR, Tobias JD. Dexmedetomidine controls the hemodynamic manifestations of tourniquet pain. Am J Ther. 2011;18:e35–9. [PubMed] [Google Scholar]
29. Lee DH, Jee DL, Kim SY, Kim JM, Lee HM. Magnesium sulphate attenuates tourniquet-induced hypertension and spinal c-fos mRNA expression: A comparison with ketamine. J Int Med Res. 2006;34:573–84. [PubMed] [Google Scholar]
30. Honarmand A, Safavi MR. Preoperative oral dextromethorphan vs. clonidine to prevent tourniquet-induced cardiovascular responses in orthopaedic patients under general anaesthesia. Eur J Anaesthesiol. 2007;24:511–5. [PubMed] [Google Scholar]
31. Jung JY, Han JH, Yi JW, Kang JM. Remifentanil prevents tourniquet-induced arterial pressure increase in elderly orthopedic patients under sevoflurane/N2O general anesthesia. Int J Med Sci. 2012;9:311–5. [PMC free article] [PubMed] [Google Scholar]
32. Shinoda T, Murakami W, Takamichi Y, Iizuka H, Tanaka M, Kuwasako Y. Effect of remifentanil infusion rate on stress response in orthopedic surgery using a tourniquet application. BMC Anesthesiol. 2013;13:14. [PMC free article] [PubMed] [Google Scholar]
33. Panerai RB, Saeed NP, Robinson TG. Cerebrovascular effects of the thigh cuff maneuver. Am J Physiol Heart Circ Physiol. 2015;308:H688–96. [PMC free article] [PubMed] [Google Scholar]
34. Hinohara H, Kadoi Y, Ide M, Kuroda M, Saito S, Mizutani A. Differential effects of hyperventilation on cerebral blood flow velocity after tourniquet deflation during sevoflurane, isoflurane, or propofol anesthesia. J Anesth. 2010;24:587–93. [PubMed] [Google Scholar]
35. Zaman SM, Islam MM, Chowdhury KK, Rickta D, Ireen ST, Choudhury MR, et al. Haemodynamic and end tidal CO2 changes state after inflation and deflation of pneumatic tourniquet on extremities. Mymensingh Med J. 2010;19:524–8. [PubMed] [Google Scholar]
36. Kageyama K, Nakajima Y, Shibasaki M, Hashimoto S, Mizobe T. Increased platelet, leukocyte, and endothelial cell activity are associated with increased coagulability in patients after total knee arthroplasty. J Thromb Haemost. 2007;5:738–45. [PubMed] [Google Scholar]
37. Reikerås O, Clementsen T. Time course of thrombosis and fibrinolysis in total knee arthroplasty with tourniquet application. Local versus systemic activations. J Thromb Thrombolysis. 2009;28:425–8. [PubMed] [Google Scholar]
38. Watanabe H, Kikkawa I, Madoiwa S, Sekiya H, Hayasaka S, Sakata Y. Changes in blood coagulation-fibrinolysis markers by pneumatic tourniquet during total knee joint arthroplasty with venous thromboembolism. J Arthroplasty. 2014;29:569–73. [PubMed] [Google Scholar]
39. Zhang W, Li N, Chen S, Tan Y, Al-Aidaros M, Chen L. The effects of a tourniquet used in total knee arthroplasty: A meta-analysis. J Orthop Surg Res. 2014;9:13. [PMC free article] [PubMed] [Google Scholar]
40. Abbas K, Raza H, Umer M, Hafeez K. Effect of early release of tourniquet in total knee arthroplasty. J Coll Physicians Surg Pak. 2013;23:562–5. [PubMed] [Google Scholar]
41. Fisher B, Roberts CS. Tourniquet use and sickle cell hemoglobinopathy: How should we proceed? South Med J. 2010;103:1156–60. [PubMed] [Google Scholar]
42. Chon JY, Lee JY. The effects of surgery type and duration of tourniquet inflation on body temperature. J Int Med Res. 2012;40:358–65. [PubMed] [Google Scholar]
43. Kim YS, Jeon YS, Lee JA, Park WK, Koh HS, Joo JD, et al. Intra-operative warming with a forced-air warmer in preventing hypothermia after tourniquet deflation in elderly patients. J Int Med Res. 2009;37:1457–64. [PubMed] [Google Scholar]
44. Crews JC, Cahall MA. An investigation of the neurophysiologic mechanisms of tourniquet-related pain: Changes in spontaneous activity and receptive field size in spinal dorsal horn neurons. Reg Anesth Pain Med. 1999;24:102–9. [PubMed] [Google Scholar]
45. MacIver MB, Tanelian DL. Activation of C fibers by metabolic perturbations associated with tourniquet ischemia. Anesthesiology. 1992;76:617–23. [PubMed] [Google Scholar]
46. Chabel C, Russell LC, Lee R. Tourniquet-induced limb ischemia: A neurophysiologic animal model. Anesthesiology. 1990;72:1038–44. [PubMed] [Google Scholar]
47. Park JW, Jung YH, Baek CW, Kang H, Cha SM. Effects of low dose ketamine on tourniquet-induced haemodynamic responses during general anaesthesia. J Int Med Res. 2007;35:600–8. [PubMed] [Google Scholar]
48. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70:195–283. [PubMed] [Google Scholar]
49. Denholm B. Administering prophylactic antibiotics during tourniquet-assisted procedures. AORN J. 2013;98:653–62. [Google Scholar]
50. Tomita M, Motokawa S. Effects of air tourniquet on the antibiotics concentration, in bone marrow, injected just before the start of operation. Mod Rheumatol. 2007;17:409–12. [PubMed] [Google Scholar]
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Some stages of development of tourniquet