Practice Safety Alerts

Reducing risks of tourniquets left on after finger and toe surgery: summary of a safety report from the National Patient Safety Agency

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c1981 (Published 21 April 2010) Cite this as: BMJ 2010;340:c1981
  1. Tara Lamont, head of response1,
  2. Frances Watts, patient safety lead (surgery)1,
  3. John Stanley, consultant in hand and upper limb surgery2,
  4. John Scarpello, deputy medical director1,
  5. Sukhmeet Panesar, clinical adviser1
  1. 1National Reporting and Learning Service, National Patient Safety Agency, London W1T 5HD
  2. 2Wrightington Hospital Upper Limb Unit, Wigan WN6 9EP
  1. Correspondence to: T Lamont tara.lamont{at}npsa.nhs.uk

    Why read this summary?

    Tourniquets are used in hand and foot surgery because of the need for a bloodless field to allow for careful dissection. They are used in a range of settings, such as operating theatres, emergency departments, community sites (for example, for minor surgery in podiatry clinics). Although rare, complications can lead to serious harm, including, at worst, irreversible ischaemia.

    Between August 2005 and November 2009, healthcare staff in England and Wales reported 15 serious incidents in which tourniquets had been left on fingers or toes by mistake. Ten patients needed further surgery and two incidents resulted in amputation. At least six of the incidents related to surgical gloves being used as tourniquets. Fourteen litigation claims relating to tourniquets were also reported in this period.

    A typical incident report reads: “Patient had termination of tip of right ring finger. He attended plastic dressing clinic for routine follow up. When the dressing was removed, his ring finger was necrotic and still had what looked like a glove tourniquet in situ. Explained to patient he will require …

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