Tourniquet (junctional): Difference between revisions

Latest revision as of 21:58, 29 June 2021

Background

Anterior thigh anatomy (right) showing vein medial to artery and nerve.

Junctional tourniquets are devices that allow for proximal compression of arterial bleeding and thus control of junctional hemorrhage
Junctional tourniquets (JTQ) were initially cleared by FDA in 2010 for use in pre-hospital medicine
Developed because of limitations of traditional extremity tourniquets in controlling hemorrhage between the trunk and limbs. These difficult to access locations were responsible for 20% of preventable deaths by bleeding on the battlefield.
Testing has shown JTQ to be 75-100% effect in controlling hemorrhage

Properties of a good junctional tourniquet

iTClamp™.

SAM-JT™.

JETT™.

AAJT™.

Stop bleeding effectively from junction areas such as groin, pelvis, shoulder, or neck
Compress bleeding from sites where regular TQ cannot be applied
Safe to use
Effective for prehospital use
Small with low profile
Lightweight
Low-cost
Easy to use requiring minimal training
Applied quickly
Does not slip on tightening when in use
Provides easy release of compression
Easy to reapply
Long shelf life

Indications

Junctional hemorrhage not controlled by other means

Contraindications

None

Application of Junctional Tourniquet

Application varies by tourniquet design (multiple different types of junctional tourniquet exist)
Clearly mark tourniquet with time of application

Proper removal in hospital setting

Loosen the tourniquet while observing wound for bleeding
If wound now hemostatic, leave pressure off
If wound continues to bleed, re-apply pressure and prepare for urgent definitive management of bleeding

External Links

Videos

References

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-* Junctional Tourniquets (JTQ) were initially cleared by FDA in 2010 for use in pre-hospital medicine
+[[File:Sobo 1909 573-574.png|thumb|Anterior thigh anatomy (right) showing vein medial to artery and nerve.]]
-* JTQs were developed because of limitations of traditional extremity tourniquets in controlling hemorrhage between the trunk and limbs. These difficult to access locations were responsible for 20% of preventable deaths by bleeding on the battlefield.
+*Junctional tourniquets are devices that allow for proximal compression of arterial bleeding and thus control of junctional hemorrhage
-* JTQs are devices that allow for proximal compression of arterial bleeding and thus control of junctional hemorrhage.
+*Junctional tourniquets (JTQ) were initially cleared by FDA in 2010 for use in pre-hospital medicine
-* Lethality of junctional hemorrhage is greater because of the large lumen size of injured vessels
+*Developed because of limitations of traditional extremity tourniquets in controlling hemorrhage between the trunk and limbs. These difficult to access locations were responsible for 20% of preventable deaths by bleeding on the battlefield.
+*Testing has shown JTQ to be 75-100% effect in controlling hemorrhage
-==Desirable Traits of a JTQ==
+==Properties of a good junctional tourniquet==
-* Stop bleeding effectively from junction areas such as groin, pelvis, buttock, shoulder, or neck
+[[File:PMC5022193 13049 2016 301 Fig2 HTML.png|thumb|iTClamp™.]]
-* Compress bleeding from sites where regular TQ cannot be applied
+[[File:PMC5022193 13049 2016 301 Fig5 HTML.png|thumb|SAM-JT™.]]
-* Safe to use
+[[File:PMC5022193 13049 2016 301 Fig4 HTML.png|thumb|JETT™.]]
-* Effective for prehospital use
+[[File:PMC5022193 13049 2016 301 Fig3 HTML.png|thumb|AAJT™.]]
-* Small with low profile
+*Stop bleeding effectively from junction areas such as groin, pelvis, shoulder, or neck
-* Lightweight
+*Compress bleeding from sites where regular TQ cannot be applied
-* Low-cost
+*Safe to use
-* Easy to use requiring minimal training
+*Effective for prehospital use
-* Applied quickly
+*Small with low profile
-* Does not slip on tightening when in use
+*Lightweight
-* Provides easy release of compression
+*Low-cost
-* Easy to reapply
+*Easy to use requiring minimal training
-* Long shelf life
+*Applied quickly
+*Does not slip on tightening when in use
+*Provides easy release of compression
+*Easy to reapply
+*Long shelf life
 ==Indications==
-* Junctional hemorrhage not controlled by pressure dressing
+*Junctional hemorrhage not controlled by other means
-* Some JTQ can also be used to stabilize suspected pelvic fractures
-* Testing has shown JTQ to be 75-100% effect in controlling hemorrhage
 ==Contraindications==
-* Not applicable
+*None
-: ''N.B. there is on the market a truncal tourniquet which has been cleared by the FDA for junctional hemorrhage. This device is contraindicated in pregnancy, abdominal aortic aneurysm, and penetrating abdominal trauma.
-''
-==Application of Tourniquet==
+==Application of Junctional Tourniquet==
-* As per manufacturer's guidance
+*Application varies by tourniquet design (multiple different types of junctional tourniquet exist)
-* Committee on Tactical Combat Casualty Care lists three possible devices
+*Clearly mark tourniquet with time of application
-==Precautions==
+==Proper removal in hospital setting==
-* Do not remove JTQ which has been in place more than 6 hours
+*Loosen the tourniquet while observing wound for bleeding
-* Expose and clearly mark all tourniquets with time of application
+*If wound now hemostatic, leave pressure off
+*If wound continues to bleed, re-apply pressure and prepare for urgent definitive management of bleeding
-==Proper Removal==
+==See Also==
-* ASAP convert junctional tourniquet to hemostatic pressure dressing if:
+*[[Resuscitative endovascular balloon occlusion of the aorta]]
-** Patient not in shock
+*[[Tourniquet]]
-** It is possible to monitor the wound closely for bleeding
-** JTQ is not being used to control bleeding form an amputated extremity or to stabilize a suspected pelvic fracture
+==External Links==
-* If bleeding recurs after removal in hospital consider non-surgical interventions such as direct pelvic packing, vessel ligation, Foley or extravascular balloon tamponade although specific technique will depend on resources and skills available
+===Videos===
+{{#widget:YouTube|id=1iP0IbO9Gog}}
 ==References==
 <references/>
-# Kragh, J.F., Jr., et al., Testing of junctional tourniquets by military medics to control simulated groin hemorrhage. J Spec Oper Med, 2014. 14(3): p. 58-63.
-# Klotz, J.K., et al., First case report of SAM(r) Junctional tourniquet use in Afghanistan to control inguinal hemorrhage on the battlefield. J Spec Oper Med, 2014. 14(2): p. 1-5.
-# Kragh, J.F., et al., Assessment of Groin Application of Junctional Tourniquets in a Manikin Model. Prehosp Disaster Med, 2016. 31(4): p. 358-63.
-# Kotwal, R.S., et al. Management of Junctional Hemorrhage in Tactical Combat Casualty Care: TCCC Guidelines-Proposed Change 13-03. J Spec Oper Med, 2013. 13(4): 85-93.
 [[Category:Military]]
+[[Category:EMS]]
+[[Category:Procedures]]
+[[Category:Trauma]]