Beware of the Forgotten Tourniquet During Phlebotomy and IV Insertion

Over the past several years more than a thousand event reports of staff forgetting to remove tourniquets from patients following intravenous (IV) insertion or phlebotomy were submitted to the Pennsylvania Patient Safety Reporting System (PA-PSRS).Unfortunately, this issue persists despite being identified 20 years ago in a study with PA-PSRS data. 1Impact of Forgotten Tourniquet on the Patient.A prior study of reports submitted to PA-PSRS found that when accidental retention of a tourniquet occurred, patients often had one or more of the following symptoms: pain; numbness; tingling; skin tear; IV infiltration; delay of capillary refill; and extremity edema, temperature change, and color change. 1An extended delay in the removal of a tourniquet can cause neurological, muscular, circulatory, and/or vascular injury. [1][2]2][3] Additionally, prolonged retention of a tourniquet can result in inaccurate laboratory test results (e.g., potassium level or blood count), which could lead to errors in patient care and treatment. 1 Circumstances of the Events and Why Staff Forget to Remove a Tourniquet.Previous research revealed that in more than 30% of events the tourniquet was applied for more than two hours and up to as many as 24 hours. 1,4When the forgotten tourniquet was detected, it was most often identified by staff other than the person who applied the tourniquet 1 and in 5%-10% of the events it was recognized by the patient or family. 1,4According to prior studies, 1,2,4 the forgotten tourniquet was attributed to one or more of the following factors: tourniquet was short in length, similar to skin color, and/or it was covered by other items (e.g., gown, drapes, blood pressure cuff, restraints, patient's fatty tissue); staff were distracted and/or inexperienced; communication breakdown between staff; patient had a condition or state that hindered meaningful communication (e.g., dementia, unconscious, non-English speaking, or nonverbal); a less common access site was used (e.g., foot, ankle); an alternative material was used as the tourniquet (e.g., blood pressure cuff, glove); and low lighting limited visibility.