Exsanguination of the upper limb in hand surgery comparison of four methods

Colville, J.; Small, J.O.

doi:10.1016/0266-7681(86)90187-7

Cited by 14 publications

(14 citation statements)

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“…The scintigraphic method which we used is both more precise and physiological than plethysmography for the measurement of changes in the blood volume in the limbs. 2 In this study we have evaluated various methods of exsanguination of the upper limbs including elevation alone, the use of bandages, the squeeze method, 7 the Urias bag 8,9 and elevation for longer than 30 seconds.…”

Section: (In 1909) and Warren Hardiman Andmentioning

confidence: 99%

Exsanguination of the upper limb in healthy young volunteers

Blønd

Madsen

2002

The Journal of Bone and Joint Surgery

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Section: (In 1909) and Warren Hardiman Andmentioning

confidence: 99%

Exsanguination of the upper limb in healthy young volunteers

Blønd

Madsen

2002

The Journal of Bone and Joint Surgery

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“…In this study we have evaluated various methods of exsanguination of the upper limbs including elevation alone, the use of bandages, the squeeze method, 7 the Urias bag 8,9 and elevation for longer than 30 seconds.…”

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confidence: 99%

“…10 The squeeze method is a hand-over-hand procedure on the elevated arm starting with a squeeze of the examined hand and quickly proceeding proximally, displacing the volume of blood into the upper arm proximal to the tourniquet. 7 The Urias bag is an inflatable arm splint intended for stabilisation of fractures as an emergency procedure. The splint was inflated with compressed air to a pressure of 200 mmHg.…”

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confidence: 99%

Exsanguination of the upper limb in healthy young volunteers

Blond

2002

The Journal of Bone and Joint Surgery. British volume

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U sing a scintigraphic technique based on an autologous injection of 99mTc-labelled erythrocytes, we have evaluated the efficiency of different exsanguination procedures in the upper limb of ten healthy male volunteers. The methods were elevation alone, the use of the Esmarch bandage or a gauze bandage, the Pomidor roll-cuff, the squeeze method and the Urias bag.The various procedures gave the following median percentage reductions of blood volumes: elevation for 5 seconds 44%, 15 seconds 45%, 30 seconds 46%, 60 seconds 46% and 4 minutes 42%, the Esmarch bandage 69%, a gauze bandage 63%, the Pomidor roll-cuff 66%, the squeeze method 53%, and the Urias bag 57%. With regard to elevation alone no significant differences were found. All the external methods were significantly more effective than elevation alone. Overall, the squeeze method was found to be the best method of exsanguination before inflation of a tourniquet, because it is effective, fast, practical and inexpensive. It is generally accepted that operations on the limbs are made easier by the use of a tourniquet. In order to reduce the amount of blood in the limb it is exsanguinated before the tourniquet is inflated. In a recent study we have compared different techniques of exsanguination of the lower limb 1 using a scintigraphic method. In this study we have evaluated various methods of exsanguination of the upper limbs including elevation alone, the use of bandages, the squeeze method, 7 the Urias bag 8,9 and elevation for longer than 30 seconds. Subjects and MethodsTen healthy male volunteers with a mean age of 26 years (20 to 34), a mean height of 186 cm (174 to 202) and mean weight of 86 kg (74 to 104) participated in the study. The local Ethical Committee approved the study and the subjects gave written informed consent. The method for the evaluation of changes in the blood volume was based on the autologous injection of 99m Tcradiolabelled erythrocytes and the use of a pneumatic tourniquet. 2 Each subject was placed supine with the arm on a gamma camera. A one-minute scintigram of the forearm and hand was obtained before and after exsanguination. In order to have a consistently reproducible position of a region of interest (ROI) for subsequent integration of radioactivity a 57Co source was placed 3 cm distal to the medial epicondyle of the humerus. For the ROI we used the smallest rectangle which included the right hand and the part of the right forearm distal to the marking. The same ROI was used for all measurements in each subject. Examples of scintigrams are given in Figure 1. The percentage reduction of blood volume was then calculated from counts obtained before and after exsanguination.The following types of exsanguination procedures were tested: elevation alone, the use of the Esmarch bandage, a gauze bandage, the Pomidor roll-cuff (Pomidor AB, Varnamo, Sweden), the squeeze method, and the Urias bag. For elevation the examiner lifted the arm to a vertical position for 5, 15, 30 and 60 seconds and 4 minutes, respectively. The external meth...

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“…9 The authors in the present article found that the brachial artery is more reliably compressed in the cubital fossa. The nature and speed of the technique make it very suitable to facilitating operations where the tourniquet has to be applied more than once.…”

Section: Discussionmentioning

confidence: 46%

“…1). 8,9 During regional or general anesthesia, this is achieved by holding the patient's fingertips if these are uninjured: otherwise the wrist is held. Then, with compression on the artery being maintained, the arm is immediately elevated into the high vertical position (Fig.…”

Section: Techniquementioning

confidence: 99%

Refinement of a Simple Technique With New Relevance for Exsanguination of the Upper Limb

Iyer

Pabari

Branford

2011

Techniques in Hand &Amp; Upper Extremity Surgery

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Many techniques have been described for exsanguination of the upper limb before the application of a pneumatic tourniquet. These require additional equipment such as the Esmarch bandage, the Urias bag, the Pomidor roll-cuff, the Northwick Park exsanguinator, or the Rhys-Davies exsanguinator. At a time of increasing demand on scarce resources and increasing medico-legal claims, these techniques have a number of disadvantages: increasing tourniquet and theater time, having cost implications, posing a risk of transmission of infection such as methicillin-resistant Staphylococcus aureus and Group A Streptococcus, being contraindicated in certain upper limb pathologies, and causing potential injury or even fatal pulmonary embolism. Some of these techniques continue to be in common usage but a review of the literature suggests that they may be unnecessary in routine practice, and should be reserved for select situations. The present article describes the formalization and refinement of a simple technique with new relevance, 101 years after Bier first mentioned it in the literature, where the brachial artery is compressed in the cubital fossa before elevation of the arm and then the tourniquet is inflated. This method is simple, cost-effective, time-saving, and most importantly safe and fomite free.

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Exsanguination of the upper limb in hand surgery comparison of four methods

Abstract: Four methods of exsanguination of the upper limb during hand surgery were compared by a randomised blind trial in one hundred patients. Exsanguination by a method of hand-over-hand compression proved ideal in 92% of cases. The advantages of this technique are discussed.

Cited by 14 publications

References 4 publications

Exsanguination of the upper limb in healthy young volunteers

Exsanguination of the upper limb in healthy young volunteers

Exsanguination of the upper limb in healthy young volunteers

Refinement of a Simple Technique With New Relevance for Exsanguination of the Upper Limb

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