Tourniquet (junctional)

Background

• Junctional Tourniquets (JTQ) were initially cleared by FDA in 2010 for use in pre-hospital medicine
• 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.
• JTQs are devices that allow for proximal compression of arterial bleeding and thus control of junctional hemorrhage.
• Lethality of junctional hemorrhage is greater because of the large lumen size of injured vessels

Desirable Traits of a JTQ

• Stop bleeding effectively from junction areas such as groin, pelvis, buttock, 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 pressure dressing
• 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

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

• As per manufacturer's guidance
• Committee on Tactical Combat Casualty Care lists three possible devices

Precautions

• Do not remove JTQ which has been in place more than 6 hours
• Expose and clearly mark all tourniquets with time of application

Proper Removal

• ASAP convert junctional tourniquet to hemostatic pressure dressing if:
  • Patient not in shock
  • 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
• 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