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Lesson

Tourniquet Application

10 min Trauma Skip to quiz

Objective: Tighten a tourniquet until arterial bleeding stops and the distal pulse is gone. For a deliberate placement, put it on skin, 2 to 3 inches above the wound, and not over a joint. Write the time. A loose band that only blocks veins can make bleeding worse.

Why this matters

A tourniquet that looks applied and is still bleeding is often tight enough to block veins and not tight enough to stop the artery. That is a venous tourniquet, and it can make bleeding worse. First, place the tourniquet and tighten it until the bleeding stops and the distal pulse is gone. Check the site and the pulse. Do not place a deliberate tourniquet over a joint, and do not leave it loose.

For a deliberate limb tourniquet, place it on the skin, 2 to 3 inches above the wound. Do not place it over the elbow or the knee. Write the time. If the first one fails, place a second one beside it, closer to the trunk.

Key points
  • Write the time on the tourniquet or on the patient's skin, where the receiving team will see it. They will ask.
  • Do not loosen it at the hospital door to see if the patient still needs it. Move to a deliberate tourniquet closer to the wound only if you are trained, the new one holds, and protocol allows it.
  • Groin, axilla, and neck bleeding are not limb-tourniquet problems. Those are packing problems. This lesson is about extremities.
Verbalize
  • This is an extremity artery. I am placing a tourniquet now.
  • I will place it on the skin, 2 to 3 inches above the wound, and not over a joint.
  • I will turn the windlass until the bleeding stops and the distal pulse is gone. Then I will lock it and write the time. The windlass is the rod that tightens the strap.
  • It is still bleeding. I will add a second tourniquet closer to the trunk. I will not loosen the first one to look.
Deliberate tourniquet placement and high-and-tight placement A deliberate tourniquet goes on skin, 2 to 3 inches above the wound, not over a joint. If the wound cannot be seen, place it high and tight. Tighten until bleeding stops and the distal pulse is gone. Deliberate: above the wound not the knee wound 2 to 3 in. above wound On skin. Not over the knee or the elbow. Windlass until bleeding stops. The distal pulse should be gone. A loose band can block veins only. If you cannot see the wound Place it high and tight, near the trunk. Over clothing if you must. Write the time.
A deliberate tourniquet goes on the skin, 2 to 3 inches above the wound, and not over the knee or the elbow. Turn the windlass until the bleeding stops and the distal pulse is gone. A loose band can block the veins and leave the artery open. If you cannot see the wound, place the tourniquet high and tight, near the trunk, over clothing if you must. Write the time.

Clinical sequence

  1. If an extremity artery is bleeding heavily, place a tourniquet now. Do not wait for a perfect exam.
  2. Place it on skin, 2 to 3 inches above the wound, and not over a joint. Turn the windlass until the bleeding stops and the distal pulse is gone. Lock it. Write the time.
  3. If it is still bleeding, add a second tourniquet closer to the trunk, or side by side with the first. Do not loosen the first one to look.
  4. Groin, axilla, and neck bleeding are packing problems, not limb-tourniquet problems. Recheck the tourniquet after every move. Packaging can loosen a windlass.

Hasty vs Deliberate

  • In chaos, such as an active threat or a dark scene where you cannot see the wound, place the tourniquet high and tight. Put it over clothing if you must. Place it as close to the trunk as you need to stop the bleeding.
  • Move to a deliberate tourniquet when you can. Expose the limb. Place a tourniquet on the skin, 2 to 3 inches above the wound, and tighten it. Then slowly release the high one if the new one holds. Do not do this if you are minutes from the trauma bay and the first tourniquet is working, or if the change would restart bleeding you cannot control.

Teaching points

  • A commercial windlass device you train with is better than an improvised belt. A working improvised tourniquet is still better than a light dressing on a stump that is still bleeding.
  • Use a wide strap. A narrow cord cuts tissue and often fails.
  • Write the time on the tourniquet and in the chart. Tell the receiving team.
  • Recheck after every move. Boards, sheets, and seat belts can loosen a windlass.
  • Junctional bleeding at the groin, axilla, or neck is not a limb-tourniquet problem. See wound packing.

Common errors

  • Placing the tourniquet over the knee because that is where the strap landed.
  • Loosening it every few minutes to see if the patient still needs it.
  • Turning the windlass only a little while a femoral artery is still bleeding.

Practice

One-minute check

On a training limb, time the tourniquet you actually carry until a simulated pulse is gone. Say the time. Have a partner try to slide two fingers under the strap. If they can, the tourniquet is not done.

Related: Massive Hemorrhage First, Wound Packing.

Sources & Further Study

Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.

Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.

Check Your Understanding

Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.

1. Where is a deliberate limb tourniquet placed?
2. If the first tourniquet does not stop the bleed:
3. A tourniquet that is only venous-tight (not arterial) can:
4. You should document and report:
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