Venipuncture Procedures: Tourniquet Use

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Course Objectives
  • Recognize the critical role of tourniquet use in the success of venipuncture.
  • Apply proper tourniquet techniques in accordance with industry standards.
  • Evaluate the impact of improper application on sample integrity and patient outcomes.
Course Content
Course Creator: Nichelle Volker RMA
Total CE Hours: 1 Credit Hour 
Pace Course #: 586-2310-25

Key Terms:
1. Tourniquet
2. Venipuncture
3. Hemostasis
4. Petechiae
5. Vasoconstriction
6. Hemoconcentration

Outline:
  • Why Tourniquet Use Matters – Clinical Relevance
    • Critical for Successful Blood Draws
    • Prolonged Use Skews Results
    • Contributes to Pre-analytical Errors
  • The Evolution of Tourniquet
    • Origins in Ancient Medicine
      • Tourniquets in Early Civilizations
    • Material Innovation Through Time
      • From Leather to Latex: Tourniquet Material Timeline
    • Tourniquets in Military Medicine
      • Tourniquets on the Frontlines: Military-Driven Innovation
    • Modern Tourniquets: Inspired By The Battlefield
      • From Combat to Clinical: Tourniquets in Today’s Healthcare
  • Tourniquet Fundamentals
    • Purpose of a Tourniquet in Venipuncture
      • Why tourniquets are used
    • Types of Tourniquets
      • Latex vs. Latex-Free
      • Buckle Tourniquets
      • Velcro Tourniquets
      • Disposable (Single-Use) Tourniquets
    • Proper Tourniquet Placement
      • Best Practices for Placement
      • Key Technique Tips
      • Common Mistakes to Avoid
    • Time Limits – Why It Matters
      • Tourniquet Application Time
      • Why This Matters
    • Effect on Blood Test Accuracy
      • Prolonged Tourniquet Use Can Alter Test Results
      • Why It Matters
    • Signs of Improper Application
      • How to Recognize Improper Tourniquet Use
    • The One-Handed Release Technique
      • Why It Matters
  • Clinical Application Practice Scenarios
    • Obese Patient – Vein Location Challenge
    • Anxious Patient – Delayed Draw
    • Over-Tightened Tourniquet – Skin Damage
    • Tourniquet Left On – Skewed Results
    • Latex Allergy – Adverse Reaction
  • Patient Safety & Special Considerations
    • Risks of Prolonged Use
      • Hemoconcentration
        • Impact on Lab Test
      • Risks of Prolonged Use
        • Petechiae
        • Nerve Damage
        • Tourniquet Palsy
    • Pediatric Use of Tourniquets
      • What You Need to Know
      • Best Practices in Pediatric Care
    • Elderly Patient Considerations
      • What You Need to Know
      • Smart Strategies for Success
    • Latex Sensitivities and Alternatives
      • What You Need to Know
      • Prevention in Practice
    • Infections and Reuse Policies
      • What You Need to Know
      • Safe Handling Guidelines
  • Troubleshooting Techniques
    • Vein Collapse – Understanding the Causes
      • Vein Collapse
      • Why it happens
      • Tourniquet’s Role
    • When Blood Flow is Too Slow
      • Common Causes
      • Fixes
    • Petechiae or Bruising After Tourniquet Use
      • What It Means
      • Causes
      • Prevent It
    • Tourniquet Placement Errors
      • Common Mistakes
      • Consequences
      • Best Practices
  • Uncommon Draw Sites & Modified Technique
    • Dorsal Hand Draws
      • Key Points
      • Considerations
    • Tourniquet-Free Draws
      • Key Points
      • When Appropriate
    • Central Line Awareness
      • What is a Central Line
      • Common types
        • PICC line
        • Port-a-Cath• Non-tunneled central lines
    • Limb Alerts
      • What is a Limb Alert
      • Common Reasons for Limb Alerts:
        • History of mastectomy or lymph node dissection
        • Lymphedema or risk of developing it
        • AV fistula or graft (used for dialysis)
        • Trauma, recent surgery, or vascular compromise
      • Phlebotomy Implications
  • Anatomy, Errors, and Application
    • Blood Flow and Vein Physiology
      • Understanding Vein Physiology – Why the Tourniquet Works
      • Applied Physiology
      • Key Concepts
    • The Risks of Over-tight Tourniquets
      • Tourniquet Trouble – When Tight Becomes Dangerous
    • Pre-analytical Errors – Where Things Go Wrong
      • How Tourniquet Misuse Skews Results
      • Key consequences include
      • Tourniquet Relevance
      • Pre-analytical Errors Dominate
      • Tourniquet Misuse: A Key Contributor
      • Impact on Laboratory Results
  • Myth vs. Fact – Tourniquet Edition
  • Recap & Review

References: 
  1. Eaton, E. K. (2022). A Fundamental Guide To Phlebotomy (1st ed.). NHCO-National Healthcare Organization.
  2. (n.d.). Preanalytical variation and pre-examination processes. Clinical Tree. Retrieved May 21, 2025, from https://clinicalpub.com/preanalytical-variation-and-preexamination-processes/
  3. (n.d.). Mechanisms and Prevention of Injuries. Tourniquet.Org. Retrieved May 21, 2025, from https://tourniquets.org/tourniquet-injuries-mechanisms-and-prevention/
  4. (2023, August 5). A Brief History of the Tourniquet. Adam Staten. Retrieved May 21, 2025, from https://www.adamstaten.com/blog/2023/8/5/a-brief-history-of-the-tourniquet
  5. (n.d.). A Brief History of the Tourniquet. Journal Of Vascular Surgery. Retrieved May 21, 2025, from https://www.jvascsurg.org/article/S0741-5214(11)02470-0/fulltext
  6. (2023, November 1). Stop the Bleed”—The Essential Tourniquet. National Museum Of Civil War Medicine. Retrieved May 21, 2025, from https://www.civilwarmed.org/stop-the-bleed-the-essential-tourniquet
  7. Johnston, L.R., Parker, W.J., Walker, P. et al. Tourniquets. Curr Trauma Rep 10, 72–77 (2024). Retrieved May 21, 2025, https://doi.org/10.1007/s40719-024-00272-0
  8. (n.d.). Disposable Phlebotomy Tourniquets: More Than Just Big Elastic Bands. Caresfield. Retrieved May 21, 2025, from https://blog.caresfield.com/disposable-tourniquets
  9. (2024, July 15). Reusable tourniquets: Their impact on patients, planet and public purse. Nursing Times. Retrieved May 21, 2025, from https://www.nursingtimes.net/leadership/reusable-tourniquets-their-impact-on-patients-planet-and-public-purse-15-07-2024
  10. (n.d.). Understanding The Different Types of Tourniquets. True Rescue. Retrieved May 21, 2025, from https://truerescue.com/blogs/knowledge/types-of-tourniquets-explained?srsltid=AfmBOopziMhuNi0vovMp03uG_jwL08_aAHAW8Aj6RePAXhxWdPdruoJe
  11. (n.d.). Latex Allergy. OSHA. Retrieved May 26, 2025, from https://www.osha.gov/latex-allergy
  12. (n.d.). Latex Allergy. National Center on Health, Physical Activity and Disability. Retrieved May 26, 2025, from https://www.nchpad.org/resources/latex-allergies
  13. (n.d.). WHO guidelines on drawing blood: Best practices in phlebotomy. WHO. Retrieved May 26, 2025, from https://iris.who.int/handle/10665/44294
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  15. (n.d.). Tourniquet. Science Direct. Retrieved May 26, 2025, from https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/tourniquet
  16. (n.d.). Beware of the Forgotten Tourniquet During Phlebotomy and IV Insertion. Patient Safety. Retrieved May 26, 2025, from https://doi.org/10.33940/001c.128211
  17.  (2021, April 13). Appropriate Tourniquet Types in the Pediatric Population: A Systematic Review. National Library Of Medicine. Retrieved June 5, 2025, from https://pmc.ncbi.nlm.nih.gov/articles/PMC8118807
  18. (n.d.). CDC Laboratory Procedures Manuel. CDC. Retrieved June 5, 2025, from https://wwwn.cdc.gov/nchs/data/nhanes/public/2021/manuals/2021-Laboratory-Procedures-508.pdf
  19. Thoolen SJJ, Kuypers MI. External Hemorrhage Control Techniques for Human Space Exploration: Lessons from the Battlefield. Wilderness & Environmental Medicine. 2023;34(2):231-242. doi:10.1016/j.wem.2023.01.006 https://journals.sagepub.com/doi/full/10.1016/j.wem.2023.01.006#
  20. (n.d.). Complete Guide to Latex Allergy. Allergy & Asthma Network. Retrieved June 5, 2025, from https://allergyasthmanetwork.org/allergies/latex-allergy
  21. Szymczyk, J., Kurpas, M., Krasiński, B., Zorena, K., & Mędrzycka-Dąbrowska, W. (2025). Reusable Tourniquets as Potential Transmitters of Infection: A Microbiological Analysis. Microorganisms, 13(1), 152. https://doi.org/10.3390/microorganisms13010152
  22.  (2022). A Fundamental Guide To Phlebotomy. NHCO – National Healthcare Certification Organization.
  23. (n.d.). Tourniquet Application to Facilitate Axillary Venous Access in Percutaneous Central Venous Catheterization. RSNA. Retrieved June 9, 2025, from https://pubs.rsna.org/doi/abs/10.1148/radiol.2263012132
  24.  (n.d.). Venipuncture and Cannulation Clinical Skills. University of Glascow. Retrieved June 14, 2025, from https://www.gla.ac.uk/media/Media_678211_smxx.pdf
  25. (n.d.). THE PREANALYTICAL ERRORS: A CONTINUOUS CHALLENGE FOR CLINICAL LABORATORIES. ASCLS. Retrieved June 14, 2025, from https://ascls.org/the-preanalytical-errors

A.  (2025). World War II Tourniquet [Photograph]. WW2 US Medical Research Centre. https://www.med-dept.com/medical-kits-contents/tourniquets/
 

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