Page 228 - 2023 SMOG Digital

TOURNIQUET CONVERSION

CLINICAL INDICATIONS:
• Wounds that have high possibility of compressible hemorrhage control with hemostatic or pressure
dressings where hemorrhage was originally controlled by a tourniquet
CONTRAINDICATIONS:
• Patient showing signs and symptoms of hypotensive/hemorrhagic shock
• Tourniquets controlling hemorrhage for amputated or partial-amputated extremity.
• Tourniquets that have been in place >6 hours.
• Unable to monitor wound for bleeding post tourniquet conversion due to task saturation, limited visibility or
poor positioning.
PROCEDURE: Limb tourniquets and junctional tourniquets should be converted to hemostatic or pressure
dressings as soon as possible if no above contraindications are present.
Every effort should be made to convert tourniquets in less than 2 hours if bleeding can be controlled with other
means. Do not remove a tourniquet that has been in place more than 6 hours.
• Confirm patient is not showing any signs of hypotensive/hemorrhagic shock.
• With Tourniquet in place, attempt to pack wound with hemostatic dressing and apply a pressure dressing.
o Combat Gauze is the CoTCCC hemostatic dressing of choice
o Alternate hemostatic adjuncts:
 Celox Gauze
 ChitoGauze
 XStat (best for deep, narrow-tract junctional wounds)
 iTClamp (may be used alone or in conjunction with hemostatic dressing or XStat)
• Loosen but don’t remove the tourniquet by unwinding the windlass until pulses return and closely monitor for
return of bleeding for 5 minutes.
• If bleeding returns, retighten tourniquet until loss of distal pulse and document procedure failure.
• If no bleeding returns, loosen tourniquet completely but leave loosely looped around limb and monitor for
return for bleeding for 5 minutes.
• If bleeding returns, retighten tourniquet until loss of distal pulse and document procedure failure.
• If no bleeding returns, document procedure success and time. Continue to monitor and assess for bleeding.
Document procedure, results, and vital signs.

228