A sterile elastic exsanguination tourniquet is effective in preventing blood loss during hemodialysis access surgery.
OBJECTIVE
We report the first use of a sterile elastic exsanguination tourniquet (SET) in performing hemodialysis vascular access procedures in 27 patients. The main advantages of this tourniquet are the reduction of blood loss and need for possible transfusions. Additional benefits are the near-perfect exsanguination and excellent exposure of the operative field.


METHODS
This SET is a sterile elastic stockinet device that rolls up the arm starting from the hand by pulling on two handles. The elastic silicone ring provides sufficient pressure (220 ± 30 mmHg) to block arterial flow into the limb. The stockinet can be cut to provide access to the incision area while providing an additional sterile cover over the rest of the limb.


RESULTS
No transfusions were required in any patients. Minor adverse effects occurred in four patients, including a twisted vessel, a bleeding vascular branch, a tear in atrophic arm skin, and pain, all of which had resolved on subsequent follow-up. Operational recommendations to avoid these adverse effects are outlined.


CONCLUSIONS
We conclude that this sterile elastic exsanguination tourniquet is effective and safe in preventing bleeding during upper extremity hemodialysis vascular access procedures.
Ladenheim Dialysis Access Centers, Fresno, California 93710, USA. eladenheim@ladenheim.net
Eric
E
Ladenheim
Juergen
J
Krauthammer
Siddartha
S
Agrawal
Craig
C
Lum
Nathan
N
Chadwick
D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D058128:Compression Bandages / Q000009:adverse effects; D004867:Equipment Design; D006488:Hemostasis, Surgical / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D011312:Pressure; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012828:Silicones; D014111:Tourniquets / Q000009:adverse effects; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*
D012828:Silicones