ZackWA2005

Here's a response I got from an RN with an emergency nursing website... From: Tom Trimble <Tom@ENW.org> To: "Zach Rinderer" <zrinderer@columbiabasin.edu> Date: 11/15/06 11:20PM Subject: Re: IV starts and tourniquets At 09:50 AM 11/15/2006, you wrote: >Hi Tom, >I did a google search about tourniquets and IV starts and eventually saw >some articles of yours. What I was trying to find is an article about a >study done on using more than one tourniquet by a flight nurse or >paramedic. Its been years since I read it but I have been using 2-3 >tourniquets on all my difficult IV starts in the ER and it appears to help >much more than not. > >Now I am teaching nursing at Columbia Basin College here in southeast >Washington State and wanted to find that article. Can you offer any >suggestions or help? Thanks no matter what and I enjoyed your website. > > >Zack Rinderer, RN >Nursing Instructor >Office 230 >Health Sciences Building >Columbia Basin College >891 Northgate Blvd. >Richlland, WA 99352 >(509) 547-0511 Ext 4016 > >Mailing address: >Columbia Basin College >2600 No. 20th Ave. >Pasco, WA 99301 Hi, Zack! No, I haven't seen an article such as you describe; so that's no help. Over the years, I've seen a bunch of people use multiple tourniquets to progressively sequester blood distally in the extremity, although I haven't used more than two at any time. Commonly, I will use a blood pressure cuff to increase venous filling. Our Phillips Intelliview monitors automated NIBP have a nifty function called "venipuncture" where with one touch of the screen the cuff will inflate automatically to a level suitable for distending veins and sustain it for three minutes then deflate; I will sometimes back this up with a distal tourniquet to ensure that I don't lose the distention before I'm through cannulating and drawing blood samples, particularly if there's no helper around. The traditional Esmarch tourniquet used to exsanguinate extremities to achieve a bloodless field for surgery could (and I believe I recall them described in print) could be used "in reverse" to sequester blood rather than exsanguinate it. The multiple tourniquets are a simple version of this. Another strategy that has been reported is to use tourniquet(s) to raise a small hand vein that can be entered with a winged needle or a small cannula so that a quantity of fluid can be infused or pushed by syringe to add to the intravascular volume of the isolated extremity possibly raising veins by restoring euvolemia or mild relative hyperemia to the limb. I hope that this is useful to you and your students and wish you all good luck. i'd be happy to exchange any other suggestions. Thanks, too, for your kind words about the website articles. It's quite appreciated.

I appreciate any replies about starting IV's and tourniquets. It is hard to sometimes find good documented research on some of the most basic tasks of nursing/emergency care. Keep 'em coming!

I have been ER nursing for over 25 years and a long time ago I read an article by either a flight nurse or paramedic that using up to 3 tourniquets when starting an IV on a trauma patient improved success rate. Has anyone knowledge of this article or other research about multiple tourniquets for IV starts? I am teaching nursing now and want to find any objective evidence about this option. Thanks!