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Fanoudi H, Torabizadeh C, Rakhshan M, Shahcheraghi GH. Development and psychometric evaluation of a pneumatic tourniquet work standards scale. J Orthop Surg Res 2024; 19:433. [PMID: 39061045 PMCID: PMC11282809 DOI: 10.1186/s13018-024-04920-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
OBJECTIVE Pneumatic tourniquets are among the most essential equipment for controlling bleeding in orthopedic surgeries. However, incorrect application of pneumatic tourniquets is accompanied by many hazards and complications for patients. Evaluation of surgical teams' use of pneumatic tourniquets and establishment of protocols can play an important role in improving patient safety, minimizing risks, and increasing the lifetime of this equipment. Accordingly, the present study was conducted to develop and assess the psychometric properties of a pneumatic tourniquet work standards scale. METHODS The present study is a methodological work carried out in two stages. In the first stage, an initial version of the scale was developed based on existing research and panel reviews. In the second stage, the psychometric properties of the scale were tested in terms of face validity (measured qualitatively and quantitatively), content validity (measured qualitatively and quantitatively), item analysis, construct validity, and reliability (internal consistency and stability). RESULTS The initial version of the scale consisted of 91 items. After several meetings of the research team, the number of items decreased to 81. In the course of face and content validity testing, 40 items were eliminated, leaving 41 items on the scale when it entered the construct validity testing stage. For evaluation of construct validity, a sample of 300 operating room nurses was recruited. The Exploratory Factor Analysis (EFA) results showed a structure supported by seven factors and 41 items. The reliability of the scale was confirmed by internal consistency analysis, with a good Cronbach's alpha (0.85), and test-retest analysis, with good values of ICC (0.95). CONCLUSION The present instrument is a reliable and valid scale which fills the gap in assessment of surgical team members' use of pneumatic tourniquets. The developed scale can be employed by researchers and managers of medical centers to identify hazards in applying pneumatic tourniquets and devise educational programs to eliminate or reduce the existing issues.
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Affiliation(s)
- Hamideh Fanoudi
- School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Camellia Torabizadeh
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mahnaz Rakhshan
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholam Hossain Shahcheraghi
- Department of Orthopaedics, School of Medicine, Bone and Joint Disease Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Zu G, Zhang Q, Chen G, Yao E, Fei J, Han G, Tian G. Knowledge, attitudes, and practices of orthopedic operating room personnel regarding the use of pneumatic tourniquets. PLoS One 2024; 19:e0307545. [PMID: 39047025 PMCID: PMC11268627 DOI: 10.1371/journal.pone.0307545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024] Open
Abstract
INTRODUCTION Pneumatic tourniquets (PTs) play a crucial role in hemostasis during orthopedic surgery. This study aimed to investigate the current knowledge, attitudes, and practices (KAP) of orthopedic operating room personnel concerning the use of PTs. METHODS This cross-sectional study was conducted from Jul. 2023 to Aug. 2023. An online questionnaire was used to collect demographic information and KAP score data of the orthopedic operating room personnel from Hangzhou Regional Hospitals. RESULTS A total of 336 participants included orthopedic physicians (37.8%), orthopedic nurses (31.5%), anesthesiologists (8.9%), operating room nurses (19.9%) and medical students (1.8%). The median knowledge score was 28.5 (24, 32), with a maximum score of 38; the median attitude score was 31 (28, 35), of a maximum of 35; the median practice score was 41 (36, 44), of a maximum of 45. Correlation analysis showed links between knowledge and attitude (r = 0.388, p<0.001), knowledge and practice (r = 0.401, p<0.001), and attitude and practice (r = 0.485, p<0.001). Multivariate logistic regression analysis confirmed that female gender (OR = 0.294, 95% CI: 0.167-0.520; p<0.001), working in a specialized hospital (OR = 0.420, 95% CI: 0.219-0.803; p = 0.009), and occupation as a surgical anesthesiologist (OR = 3.358, 95% CI: 1.466-7.694; p = 0.004) were associated with better knowledge scores. A higher educational degree (OR = 0.237, 95% CI: 0.093-0.608; p = 0.003) was associated with better practice scores. No previous training was associated with lower knowledge (OR = 0.312, 95% CI: 0.187-0.520; p<0.001) and practice (OR = 0.325, 95% CI: 0.203-0.521; p<0.001) scores. CONCLUSION Orthopedic personnel in this study had acceptable knowledge, attitude, and practice concerning the use of PTs; additional training and guidance might enhance proficiency.
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Affiliation(s)
- Gang Zu
- Department of Orthopedics, Hangzhou RedCross Hospital, Hangzhou, Zhejiang, China
| | - Quan Zhang
- Department of Orthopedics, Hangzhou RedCross Hospital, Hangzhou, Zhejiang, China
| | - Genjun Chen
- Department of Orthopedics, Hangzhou RedCross Hospital, Hangzhou, Zhejiang, China
| | - Enfeng Yao
- Department of Orthopedics, Yuhuan TCM Hospital, Taizhou, Zhejiang, China
| | - Jun Fei
- Department of Orthopedics, Hangzhou RedCross Hospital, Hangzhou, Zhejiang, China
| | - Guihe Han
- Department of Orthopedics, Hangzhou RedCross Hospital, Hangzhou, Zhejiang, China
| | - Guanmin Tian
- Department of Orthopedics, Hangzhou RedCross Hospital, Hangzhou, Zhejiang, China
- Xiaoshan Yongxin Hospital, Hangzhou, Zhejiang, China
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Mishra A, Barakat A, Mangwani J, Kazda J, Tiwatane S, Shaikh SMA, Houchen-Wolloff L, Kaushik V. Effect of ankle versus thigh tourniquets on post-operative pain in foot and ankle surgery. World J Orthop 2024; 15:163-169. [PMID: 38464352 PMCID: PMC10921181 DOI: 10.5312/wjo.v15.i2.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/19/2023] [Accepted: 01/16/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Tourniquets are commonly used in elective extremity orthopaedic surgery to reduce blood loss, improve visualization in the surgical field, and to potentially reduce surgical time. There is a lack of consensus in existing guidelines regarding the optimal tourniquet pressure, placement site, and duration of use. There is a paucity of data on the relationship between the site of a tourniquet and postoperative pain in foot and ankle surgery. AIM To explore the relationship between tourniquet site and intensity of post-operative pain scores in patients undergoing elective foot and ankle surgery. METHODS Retrospective analysis of prospectively collected data on 201 patients who underwent foot and ankle surgery in a single institution was undertaken. Intraoperative tourniquet duration, tourniquet pressure and site, and postoperative pain scores using Visual Analogue Score were collected in immediate recovery, at six hours and at 24 h post-op. Scatter plots were used to analyse the data and to assess for the statistical correlation between tourniquet pressure, duration, site, and pain scores using Pearson correlation coefficient. RESULTS All patients who underwent foot and ankle surgery had tourniquet pressure of 250 mmHg for ankle tourniquet and 300 mmHg for thigh. There was no correlation between the site of the tourniquet and pain scores in recovery, at six hours and after 24 h. There was a weak correlation between tourniquet time and Visual Analogue Score immediately post-op (r = 0.14, P = 0.04) but not at six or 24 h post-operatively. CONCLUSION This study shows that there was no statistically significant correlation between tourniquet pressure, site and post-op pain in patients undergoing foot and ankle surgery. The choice of using a tourniquet is based on the surgeon's preference, with the goal of minimizing the duration of its application at the operative site.
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Affiliation(s)
- Ashish Mishra
- Department of Trauma and Orthopedics, University Hospitals Leicester, Leicester LE1 5WW, United Kingdom
| | - Ahmed Barakat
- Department of Trauma and Orthopedics, Leicester University Hospitals-NHS Trust, Leicester LE1 5WW, Leicestershire, United Kingdom
| | - Jitendra Mangwani
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester LE3 9QP, United Kingdom
| | - Jakub Kazda
- Department of Anaesthesia, York & Scarborough Teaching Hospitals NHS Foundation Trust, North Yorkshire YO31 8HE, United Kingdom
| | - Sagar Tiwatane
- Department of Anaesthesia, Royal Free London NHS Trust, London NW3 2QG, United Kingdom
| | | | - Linzy Houchen-Wolloff
- Department of Physiotherapy, University Hospitals of Leicester NHS Trust, Leicester LE3 9QP, United Kingdom
| | - Vipul Kaushik
- Department of Anasthesia, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, United Kingdom
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Sargin S, Atik A, Aslan A. Should We Suture Arthroscopic Portals? Effects on Intra-articular Fluid Retention. J Knee Surg 2023; 36:167-172. [PMID: 34187068 DOI: 10.1055/s-0041-1731350] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Knee arthroscopy is one of the most common surgical procedures in orthopaedics and especially in sports medicine. Portal problems and effusion after knee arthroscopy have been reported. The fluid retention within the joint in knee arthroscopy can affect clinical outcomes, but there is no consensus on portal management. The studies of portal management in knee arthroscopy have mainly addressed wound healing and cosmetic problems. There is insufficient information in the literature about whether the irrigation fluid used in this effusion contributes to the process. This study investigates whether arthroscopic irrigation fluid is retained in the joint and whether portal-closure management has an effect on effusion. In this randomized, prospective study, 91 patients (46 [50.5%] sutured-portal group and 45 [49.5%] open-portal group) were included. Suprapatellar knee-diameter measurement and the number of times the dressing was changed were used to assess intra-articular fluid collection. The visual analog scale (VAS) score, Oxford knee score, and Knee Society score were used to evaluate knee problems. All portal wounds in both groups healed without any problems. Superficial or deep infection was not observed in either group. There was no statistically significant difference in VAS score, Oxford knee scores, and Knee Society scores between groups. Although there was a decrease in the knee diameter of both groups between the early postoperative period and first postoperative day, a statistically significant difference in knee diameter was found, especially in the open-portal group. There was a significant difference between the groups in terms of the number of dressings used in the first 24 hours after surgery. Leaving portals open may be effective in preventing intra-articular fluid retention. We thus advise leaving the arthroscopy portals open with just a simple dressing for selected patients.
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Affiliation(s)
- Serdar Sargin
- Department of Orthopaedics and Traumatology, Balıkesir University, Faculty of Medicine, Balıkesir, Turkey
| | - Aziz Atik
- Department of Orthopaedics and Traumatology, Balıkesir University, Faculty of Medicine, Balıkesir, Turkey
| | - Ahmet Aslan
- Departmant of Orthopaedics and Traumatology, School of Medicine, Alanya Alaaddin Keykubat University, Alanya, Turkey
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Roman P, Rodriguez-Alvarez A, Bertini-Perez D, Ropero-Padilla C, Martin-Ibañez L, Rodriguez-Arrastia M. Tourniquets as a haemorrhage control measure in military and civilian care settings: An integrative review. J Clin Nurs 2021. [PMID: 33969561 DOI: 10.1111/jocn.15834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES The aim of review was to describe and synthesise the evidence on the use of tourniquets to control haemorrhages, summarising both civilian and military use. BACKGROUND Trauma-related haemorrhage constitutes one of the most preventable deaths among injured patients, particularly in multi-casualty incidents and disasters. In this context, safe instruments such as tourniquets are essential to help healthcare professionals to minimise loss of life and maximise patient recovery. DESIGN AND METHODS An integrative review was conducted in Medline, Nursing & Allied Health Premium, and Health & Medical Collection, using published data until March 2021 and following the PRISMA guidelines. RESULTS A total of 25 articles were included. Evidence has been synthesised to understand the use of different types of tourniquets, environment of application, indication for their placement and potential complications associated with tourniquet placement. CONCLUSIONS Commercial tourniquets such as Combat Application Tourniquet or Emergency Tourniquet models are a valuable and safe instrument for haemorrhage control in both military and civilian out-of-hospital care settings. Nurses, as part of emergency teams, and other professionals should be aware that there is a possibility of adverse complications, but they are directly proportional to the time of tourniquet placement and generally temporary. In addition, national and international guidelines ensure the need for all civilian emergency services to be equipped with these devices, as well as for the training of healthcare professionals and first responders in their use. RELEVANCE TO CLINICAL PRACTICE Despite the lack of complications in the use of tourniquets in these cases, their use has been a matter of debate for decades. In this sense, this review yields up-to-date guidelines in the use of tourniquets, their recommendations and their significance among professionals to manage complicated situations.
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Affiliation(s)
- Pablo Roman
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria, Spain
- Research Group CTS-451 Health Sciences, University of Almeria, Almeria, Spain
- Health Research Centre, University of Almeria, Almeria, Spain
| | | | | | - Carmen Ropero-Padilla
- Faculty of Health Sciences, Pre-Department of Nursing, Jaume I University, Castellon de la Plana, Spain
- Research Group CYS, Faculty of Health Sciences, Jaume I University, Castello de la Plana, Spain
| | - Luis Martin-Ibañez
- Field Artillery Group, Light Infantry Brigade "King Alfonso XIII" II of the Legion, Almeria, Spain
| | - Miguel Rodriguez-Arrastia
- Faculty of Health Sciences, Pre-Department of Nursing, Jaume I University, Castellon de la Plana, Spain
- Research Group CYS, Faculty of Health Sciences, Jaume I University, Castello de la Plana, Spain
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Pinsornsak P, Pinitchanon P, Boontanapibul K. Effect of Different Tourniquet Pressure on Postoperative Pain and Complications After Total Knee Arthroplasty: A Prospective, Randomized Controlled Trial. J Arthroplasty 2021; 36:1638-1644. [PMID: 33509602 DOI: 10.1016/j.arth.2020.12.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/17/2020] [Accepted: 12/28/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Tourniquet pressure inflation is commonly selected between 100 and 150 mm Hg above the systolic blood pressure (SBP). Given the lack of evidence to support a given inflation pressure, our study aimed to ascertain the lowest tourniquet pressure that facilitated total knee arthroplasty (TKA) and resulted in the least postoperative pain and complications. METHODS In a double-blind, randomized controlled trial of patients scheduled for unilateral primary TKA, 150 were assigned to use tourniquet pressures of SBP + 75 mm Hg (group I), SBP + 100 mm Hg (group II), and SBP + 150 mm Hg (group III). The quality of the bloodless field, total blood loss, and limb swelling were determined perioperatively. Clinical outcomes were evaluated by visual analog scale for pain at thigh and surgical site, serum creatinine phosphokinase levels, wound complications, range of motion, and Knee Society Score. RESULTS Visual analog scale for pain at thigh and surgical site were lowest in group I (P < .01) and highest in group III (P < .01). However, the quality of bloodless field at the tibial cutting surface was significantly better in group III compared to group I/II but not at the femoral cutting surface. The total blood loss and limb swelling showed no difference among 3 groups. Postoperative serum creatinine phosphokinase levels at 24 and 48 hours and wound complications in group III were significantly higher than group I (P < .01) and group II (P < .01). Nevertheless, postoperative knee range of motion and Knee Society Score were not significantly different among 3 groups. CONCLUSION Post TKA, the lowest tourniquet pressure was associated with significantly less postoperative tourniquet and surgical site pain, muscle damage, and wound complications.
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Affiliation(s)
- Piya Pinsornsak
- Department of Orthopaedic Surgery, Thammasat University, Pathum Thani, Bangkok, Thailand
| | - Punnawit Pinitchanon
- Department of Orthopaedic Surgery, Thammasat University, Pathum Thani, Bangkok, Thailand
| | - Krit Boontanapibul
- Department of Orthopaedic Surgery, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Bangkok, Thailand
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