Limb exsanguination. I. the arm: effect of angle of elevation and arterial compression
Warren, P.J.; Hardiman, P.J.; Woolf, V.J.
Annals of the Royal College of Surgeons of England 74(5): 320-322
1992
ISSN/ISBN: 0035-8843 PMID: 1416703 Document Number: 398178
Limb exsanguination before tourniquet inflation is usually accomplished using mechanical devices although, where their use is contraindicated, exsanguination by elevation alone may be employed. Advice regarding duration of elevation within the literature is a little confusing with recommendations ranging from 20 s to 5 min. Volume changes, during elevation at 45 degrees and 90 degrees, were measured using strain gauge plethysmography in seven male volunteers. In addition, the superimposed effect of brachial arterial compression on elevation at 90 degrees was investigated. To achieve maximal exsanguination it is recommended that the arm should be elevated for 5 min at 90 degrees before tourniquet inflation. Supplementary brachial arterial compression is not recommended as this tends to attenuate changes in volume.