Long-Term Care

Trainer’s tip: Managing external bleeding

LTC Nursing Assistant Trainer, April 7, 2011

Direct pressure (using a gloved hand and external padding) is the action of choice for external bleeding. If direct pressure fails to control the bleeding, apply pressure to the major artery proximal to the wound. Tourniquets are used only as a last resort when all other measures have failed. Although the tourniquet will slow or stop the bleeding, it increases the risk of ischemia and necrosis, tourniquet shock, and amputation. The steps for managing external bleeding with a tourniquet include:

  • Wrap the tourniquet around the extremity, about two inches proximal to the wound.
  • Tie the tourniquet in a half-knot. Avoid tying it too loosely, which will worsen bleeding by increasing pressure and compressing the underlying blood vessels.
  • Position a pen, pencil, or stick on the top of the half-knot.
  • Use a square knot to tie the pencil, pen, or stick over the half-knot. Twist the stick until the bleeding stops.
  • Once the tourniquet has been applied, avoid loosening it.
  • Never cover a tourniquet. When you turn care over to EMS and the emergency department, notify both that the tourniquet is being used. An additional safety precaution is to write, “TK” on the resident’s forehead and the time the tourniquet was applied.

This is an excerpt from the HCPro book, The Long-Term Care Nursing Desk Reference, Second Edition, by Barbara Acello, MS, RN.

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