Braun Pneumatic

SCT Tourniquet
Range

User Instructions
Unit 11b/11c Harrier Road
Humber Bridge Industrial Estate
Barton upon Humber
North Lincolnshire
DN18 5RP
Tel: 01652 632273
Fax: 01652 633399
Email: sales@braunmedical.co.uk
www.brauninternational.com

Braun is an ISO 9001/13485
registered Company.
Certificates available on
request.



SCT 1, 2 & 2x2 User Instructions
The Braun SCT 1 model is a single channel unit intended for use on a single cuff
only.
SCT 2 & 2x2 models are a dual channel unit which can be used to supply pressure
to 2 separate cuffs or 1 single double cuff, used for Biers block technique.
Each channel is shown separately and has independent controls. The channels for
SCT 2 & 2x2 models are colour coded Blue and Black. For SCT 1 models the colour
code is black.
Operating Procedure
1. Gauges mmHG: Ensure pointers are in black section of gauge. If not flick
inflate-deflate switches to expel excess gases. If pointer still does not return to
black section it will require calibration.
2. Open cylinder valve or connect to pipeline gas supply
3. Ensure cylinder is sufficiently charged by reading off cylinder contents gauge
(if applicable)
4. Check circuit pressure gauge is reading between 16 and 20 PSI
5. Ensure regulator control dials are fully off
6. Set control switch to deflate position.
7. Apply cuff to patient
8. Set desired cuff pressure by turning regulator control dials clockwise
9. (For SCT 2x2 only) setting will be registered on pre-select pressure gauge
10. Flick control switch to inflate to apply pressure to cuff
11. (For SCT 2x2 only) setting will be registered on pre-select and cuff pressure
gauges and should be both linear.
12. Timer units commence elapsed inflation time automatically when control
switch is set to inflate. (if applicable) Time is measured in minutes and hours.
Timing stops when switch is set to deflate and elapsed time is stored. Timers
will reset automatically when cuff is re-inflated at next procedure.
13. (For SCT 2x2 only) Hand pump inflation facility to be used only if other
supplies fail. Control switch must be set to inflate position. There is no pre-
selection mode and cuff pressure gauges rise simultaneously.
14. (For all models) When not in use turn regulator control dials anti-clockwise,
set control switches to deflate and close cylinder valve or disconnect pipeline.
Important: Do not acti vate switches unless you have gas supply. If cuff
pressure gauge shows zero then the cuff is not inflated. Check cuffs for leaks,
and tubing for kinks, before use.





Warnings:
As with all tourniquets with pre-selection and self-compensation facilities it is advised
that the following points should be observed at all times.
1. All cuffs and supply tubes should be checked regularly for leaks
2. All switches must be in deflate mode before selecting desired cuff pressure
3. Prior to inflation cuff supply tubes should be checked for kinks and should not
be trapped under other equipment
4. The tourniquet must be connected to a gas supply before activation of
Inflate/Deflate switch


Safety
1. The cuff pressure gauge will show actual pressure in the cuff when the unit is
in inflate mode
If the cuff connectors are not engaged or inadvertently become disconnected,
the cuff pressure gauge will show zero
2. Channels are colour coded down to the cuff connectors. This immediately
indicates to the user which channel is in service
3. In the unlikely event of primary gas failure the cuffs will remain inflated,
provided there are no leaks in the system
N.B although a self-compensating unit this facility is not available unless a
continuous gas supply is connected
4. If cuff pressure gauge does not register a pressure, this means that the cuff is
not inflated.
5. Should small leaks occur during procedure in the cuff, supply hose or the cuff
connector, this will be compensated for up to a flow of around 2.5 litres per
minute
6. The primary pressure of 4 or 7 bar is reduced by the internal pressure
regulator to give a working pressure of between 16-20 Psi which can be
viewed on the internal pressure gauge situated on the front panel.
7. Cuff Pressure adjustment is pinned to a maximum of 600mmHg.







Routine Maintenance Checks for SCT Tourniquets and Cuffs Prior to Use:
1. Check all connectors visually and replace any O rings which appear to be
worn
2. Check all tubing visually and replace any worn or corroded parts
3. Check all cuffs for leaks
4. Ensure gauge accuracy remains at +or 5% at all times (Tested in
accordance with Braun Service Agreement)

Procedure for testing cuffs and Tourniquet unit for leaks


1) Connect cuffs to tourniquet using both channel where applicable
2) Wrap cuff around suitable former (i.e. small cylinder)
3) Connect machine to primary supply and pre-select pressure on appropriate
gauges to 450mmhg
4) Inflate both cuffs and check cuff pressure gauge against pre-select gauge.
There should be no difference greater than +/-5% (22.5mmhg)
5) Leaving the switches on inflate mode disconnect the tourniquet from the
primary gas supply. There should be no drop in pressure over a two minute
period (cuff pressure gauges). If the pressure drops check cuffs and
connectors for leaks.
6) Cuffs and connectors to be submersed in clean water and inflated for one
minute, checking for streams of bubbles which would indicate a leak. If leaks
occur replace damaged part immediately. If no leaks appear this would
indicate a fault in the Tourniquet unit. Contact Braun Engineers or EBME
department






Routine Servicing
Due to the nature of these devices it is recommended that they are subject to regular
servicing.
Braun & Co Ltd provide an annual service contract that includes 2 visits per annum
to:-
1) Check overall function
2) Re-lubricate all valves
3) Change all perishable items
4) Check gauge calibration
5) Comprehensive system leak test
6) Replace any damaged parts
General
Primary Pressure - 4 bar (60 Psi) or 7 bar (100 Psi)
Operating Pressure - 16-20Psi
Gas - Medical Compressed Air
Accuracy - +/-5%
Recommended Maintenance - every 6 months

Recommended Stock Parts
Valve O rings
Bodok Seals
Plastic Strip Ties
Male Cuff Connectors
Female Cuff Connectors
All other parts for maintenance of a Tourniquet machine are available from stock,
contact Sales for further details:
Tel: 01652 632273
Email: sales@braunmedical.co.uk




Cleaning Method

The Tourniquet unit, mobile stand and storage tray may be cleaned using a damp
cloth and compatible cleaning and disinfecting solutions approved by your
establishment for stainless steel and plated/anodised metal parts.
Apply cleaning solutions to the cloth, DO NOT use excessive amounts of liquid or
abrasive materials
Cleaning instructions for Tourniquet Cuffs should be obtained from the manufacturer.





















Tourniquet Good Practice Guide
There are different types of tourniquet used in Theatres; those using medical
compressed air supply are leak compensating pneumatic tourniquets.

The cuff is inflated by a regulated air supply, and the air supply automatically
furnishes and maintains the cuff pressure. The cuff is connected to the regulator by
an air hose. The tourniquet automatically compensates for any loss of cuff pressure
up to 2.5 ltrs/min, above this and a loss in cuff pressure will occur.
However do not mistake the constant leak compensation valve for a leak in the hose
or cuff, you can hear the valve if you place your ear next to the regulator.

The tourniquet has four main uses:
1. To maintain a bloodless operating field
2. To conserve the patients blood during surgery
3. To assist in regional block anaesthesia
4. For treatment in pain relief

Tourniquets can be employed in a variety of circumstances:
1. Peripheral joint surgery, i.e. total knee replacement.
2. Hand surgery, i.e. tendon and nerve repair.
3. Foot surgery, i.e. soft tissue release (C.T.V.S.)
4. Internal fixations of fractures of forearms, ankles and legs.
Before appl ying a tourniquet, check that:
1. The air hose and/or back air cylinder has an adequate supply.
2. The regulator is working.
3. The cuff has not got a leak in it and is large enough for the limb to which it is
being applied.
4. You have a supply of foam or velband for padding underneath the cuff.






Appl ying the Tourniquet:
1. Ensure the surgeon requires a tourniquet.
2. Ensure the correct size of tourniquet is used. It should overlap by a third.
3. Check to which limb it is to be applied.
4. Apply a layer of foam or velband padding around the limb with a small overlap
5. Apply the cuff not too tightly and not too loosely, but so that you can fit two
fingers between the foam and cuff and the limb. If the cuff is too tight, the limb
will not drain, and this will result in congestion. Similarly, if the cuff is too loose
this will result in arterial blood being allowed to flow back into the limb as the
cuff inflates, again resulting in congestion.
6. The foam and cuff should be sited at maximum distance from the opening site
when knee and elbow surgery is being carried out and at the maximum
circumference of the limb where the peripheral nerves are well protected by
soft tissue, and preferably over the humerus or femur.

Limb Exsanguination

1. Once the cuff is in place, connect it to the tubing from the tourniquet making
sure the correct side is being used i.e. blue tubing side is operated by the blue
regulator, black tubing is operated by the black regulator.
2. Check the patients systolic blood pressure with the anaesthetic nurse,
ODA/OD or the anaesthetist.
3. Use the exsanguination roll, elevate the limb and apply the exsanguinator up
to the cuff, then inflate the cuff.
4. If it is not possible to use the exsanguinator, then the limb will need to be
drained by elevation. The limb to be drained should be elevated and
supported. The arm should be held by the fingers and the back of the elbow,
and the foot by cupping your hand behind the heel. If you hold the limb by
gripping around it, this will result in congestion. The limb should be elevated
for three minutes and the cuff inflated before bringing the limb down. The area
can then be prepped.








Cuff Pressure
1. This is the prerogative of the surgeon, but as a guide upper limb pressure
should be 50mmHg above the patients systolic blood pressure and lower limb
pressure should be 100 mmHg above the patients systolic blood pressure. A
greater pressure may be required if the patient is unduly muscular or obese,
up to a pressure of twice the systolic blood pressure, but in these cases the
surgeon must be consulted.
2. The regulator pressure should be set before inflating the cuff. When all the
above stages are complete, and then inflate the cuff taking note of the time.


Duration of Tourniquet Time
1. A record of the length of time the tourniquet is inflated, the pressure and the
person responsible for inflating and deflating will need to be kept.
2. A record of the limb and length of time will be kept on the board in theatre,
and the information should be kept until the end of the list.
3. The Anaesthetic Nurse or ODA/P should inform the surgeon and the scrub
nurse when the tourniquet has been inflated for one hour. The Anaesthetic
Nurse or ODA/P must make sure that he/she receives a reply from one of
them. After the first hour, the time should be called every half hour.
4. There are still no clear cut rules as to a safe time limit for the duration of
tourniquet inflation. It is generally accepted that a time of two hours is safe. If
the time exceeds two hours, then hourly deflation are required.











Removing the Tourniquet

1. The tourniquet is generally removed after the pressure dressing has been
applied. Once the dressing has been applied, ask the surgeon if the
tourniquet can be deflated.
2. There are a few circumstances where the Anaesthetist would not like the
tourniquet to be released all at once. Do ensure the Anaesthetist is happy for
the tourniquet to be deflated.
3. Deflate the tourniquet and make a note of the time for the board, then remove
the cuff and foam/velband. Check the tourniquet site and if there is anything
untoward, draw it to the attention of the surgeon immediately.

When you have finished with the Tourniquet Cuffs and Machine:

1. Clean cuffs and machine of any blood, prep, plaster or any other matter and
check for leaks.
2. Check contents of air cylinder, and if insufficient for the next case, ensure that
it is changed.
3. Turn off the air cylinder.
4. Make sure the equipment is put away, clean and tidy, ready for use on the
next patient.