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dc.contributor.authorSalim, Hussein I A
dc.date.accessioned2019-07-30T08:30:35Z
dc.date.available2019-07-30T08:30:35Z
dc.date.issued2019
dc.identifier.urihttp://erepository.uonbi.ac.ke/handle/11295/106862
dc.description.abstractBackground: Surgical tourniquet use is widespread in various limb surgeries. Tourniquets have evolved from primitive non-inflatable/non-pneumatic types to automated personalized inflatable/pneumatic types. In deciding the tourniquet cuff inflation pressure to be applied when using pneumatic tourniquets, many users traditionally use a fixed “routine” pressure that in majority of cases is much higher than what is recommended and subsequently more detrimental. In order to minimize pressure related tourniquet complications, it is advocated to use the lowest and safest tourniquet pressure which brings about the concept of preoperative Limb Occlusion Pressure (LOP) Measurement. This pressure can be objectively measured and is of great value in guiding the tourniquet user in application of the minimum, safe and adequate tourniquet pressure to achieve a desirable bloodless surgical field and also to reduce risks of complications that may arise from using unnecessarily high pressures. Personnel involved in use of surgical tourniquets have varied knowledge and practices/ experiences when it comes to key areas pertaining to tourniquet use. Thus in order to promote safe tourniquet practices and subsequently enhance patient safety, it is important to have a survey to assess parameters pertaining to tourniquet use. Objective: To measure LOP pre-operatively in study participants presenting to KNH, in whom tourniquet use was planned or anticipated for a surgical procedure and to describe the knowledge and practices about current use of tourniquets at KNH. Study Population: Comprised two parts. The first part consisted of study participants aged 18 - 65 years who presented with unilateral lower limb injury/condition for which use of a surgical tourniquet was planned/anticipated. 2 The second group consisted of tourniquet users who were identified as anyone directly or indirectly involved during use of a surgical tourniquet. Study Site: The study was conducted at KNH. For LOP measurement, 107 consenting adult study participants were recruited from the orthopedic wards. Totally, 100 tourniquet users were recruited from departments of orthopedic surgery, plastic surgery, general surgery and anaesthesia. Methodology and Data collection: Limb Occlusion Pressure was measured pre-operatively using a manually inflatable surgical pneumatic tourniquet and dorsalis pedis arterial colour/spectral Doppler sonography to objectively identify the appearance and disappearance of the dorsalis pedis pulse waveform following gradual inflation of the pneumatic tourniquet in the selected participants. Semi-structured questionnaires were administered to tourniquet users to collect information on their knowledge and practices about key areas pertaining to tourniquet use. Results The mean LOP was 155.1(38.7 SD) mmHg. Other patient parameters evaluated were mid thigh circumference (mean 42.1cm; p-value <0.001) and this had a direct positive correlation with measured LOP. Cuff width: thigh circumference ratio (mean 0.24; P-value <0.001) had a negative correlation with measured LOP while there was negligible correlation between patients age and measured LOP (P-value 0.999). From the assessment of tourniquet users’ knowledge and practices, varied proportions were obtained from responses for different aspects pertaining to tourniquet use which included limb exsanguination, tourniquet pressures, tourniquet time, deflation intervals, indications and possible contraindications of tourniquet use, wound closure practices, tourniquet associated 3 complications, among others. However of significance, it was noted that 70% of users still used high fixed tourniquet inflation pressures which may be detrimental, and that none of the users based their tourniquet inflation pressures based on LOP. Conclusion The study revealed that majority of study participants had low limb occlusion pressures (LOP) compared to the standard fixed routine tourniquet inflation pressures traditionally employed during lower limb surgeries. Even after adding recommended pressure values in addition to measured LOP, the values were still lower as compared to traditionally used inflation pressures. None of the users were familiar with LOP measurement despite available evidence that LOP measurements enable the use of lower and safer tourniquet inflation pressures. The survey from the tourniquet users revealed that majority of tourniquet users were familiar with the types of tourniquets available. However, it was noted that 97% of tourniquet users had had no formal training in tourniquet use. Key areas pertaining to tourniquet use were all varied among tourniquet users, and therefore more ongoing formal education is necessary to streamline knowledge and practice of safe tourniquet use. The findings of this study reflect the need to adopt evaluation of Limb Occlusion Pressure before surgical pneumatic tourniquet use, with an ultimate aim to reduce pressure related tourniquet complications. The findings of the survey should guide tourniquet users to reanalyze their tourniquet use practices and make prudent evidence-based decisions when using tourniquetsen_US
dc.language.isoenen_US
dc.publisheruniversity of nairobien_US
dc.subjectCurrent Knowledge and Practiceen_US
dc.titleMeasurement of Limb Occlusion Pressure and a Survey of Current Knowledge and Practice of Peri-operative Tourniquet Use at Kenyatta National Hospitalen_US
dc.typeThesisen_US
dc.description.departmenta Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine, Moi University, Eldoret, Kenya


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