Page 46 - JSOM Summer 2019

FIGURE 6 Image depicting a modification of the technique to secure band between the clips, but the tourniquet did not fit (Figure
the rod in tourniquet use. 7). The mechanism of how the tourniquet was misfit became
newly clear as a progression from previously observed phe-
nomena. On the large limb (i.e., handrail), the 0.75-in. of band
Rod cannot be bridging the buckle and the clips (at the end of the stabiliza-
put into clip tion plate) allowed normal technique, albeit with excess band
to wrap. The plate bent to fit the limb, and the clip-buckle
abutment was untroublesome. On the medium-sized limb (i.e.,
4.25-in. pipe), the workaround was needed because the arcs
of the pipe and plate were severe. Again, the clip abutted the
buckle, but no gap formed between the plate and the limb. On
the small limb (i.e., the pole with a 3.25-in. circumference),
that gap remained and attempts to close it caused the plate to
fold up. Folding looked like it would pinch the skin of a limb.
This closure looked odd and appeared to risk pain and ineffec-
Band is tiveness. This limb was too small for a workaround. Figure 8
is a map of tourniquet fit by limb size.
wrapped to
secure rod
FIGURE 7 Image depicting a fit of a tourniquet to a small simulated
limb of an infant.

A vertical pipe with a 4.25-in. circumference has a blue tourniquet
applied. In a limb of this size, the rod cannot reach into a clip. A
workaround secured the rod by wrapping it with the band. The work-
around fit the 4.25-in. limb.

band, the insight was that the band’s excess could be wrapped
around the rod at both its ends. Such a figure-8 wrapping of
the band around the rod could secure it. The figure-8 wrap Stabilization
was made in the direction to counteract the torque present in plate is bent
the turned rod. The nondominant left hand held the rod until
the band was wrapped once around each end of the rod. That
wrapping countered the torque by holding the rod with a suffi-
ciently long moment arm. The first pass of the figure 8 around Buckle
each end held the rod still: Grip release led to no motion. The
figure-8 wrap was repeated for a second wrapping of both abuts clip
rod ends. The clips were not in the way of wrapping the band.
Then the band was routed between the clips and secured in 0.75 inch of band goes from
the usual way with the time strap, the tourniquet part which is buckle to stabilization plate
used to secure the rod and excess band within a clip.

The sturdy construct of the tourniquet was hard to move,
slide, or spin on the limb. The tourniquet could not be dis-
lodged by striking it, but it was easily removed in the usual
way of undoing the strap, unwrapping the band, and routinely
peeling back the band to release its self-adhering surfaces.
The tourniquet application was faster than on the handrail In the photograph, a supply cart has a steel pole rising vertically, and
because the figure 8 was longer than the circumference of the the user’s left hand holds a tourniquet applied around the pole. The
handrail. This startling solution had not occurred to the expert stabilization plate bends severely and the clip at the end of the plate
abuts the buckle to leave a visible gap between the tourniquet and
before. simulated limb. This limb has a circumference of 3.25 in., too small
for a workaround of the normal tourniquet technique. Notably, the
Results of a Check of Fit on a Small Pipe: self-adhering band under the thumb is adhered between the clips to
How Low Can You Go? exit the clips at the right, where the excess band drapes down toward
the floor. This between-the-clips adherence varies from normal tech-
We found a pole with a 3.25-in. circumference on a cart. nique. Normally, adherence is up to but not between the clips. In such
Again, the modification to the IFU was required to adhere the small limbs, there was no other place for adherence to be made.

44 | JSOM Volume 19, Edition 2 / Summer 2019