Sterile elastic
exsanguination tourniquets (HemaClear; OHK Medical Devices, Haifa, Israel) are relatively new on the market but are widely used because of the ease and speed of their application. The sterile elastic
exsanguination tourniquet consists of a
silicon ring wrapped in a stockinet sleeve with pull straps. The physician places the ring on the patient's fingers or toes and then pulls the straps proximally. The
silicon ring rolls up the limb, and the stockinet sleeve unrolls onto the limb. During proximal rolling, the device displaces blood out of the limb (
exsanguination). When the elastic ring reaches the preferred occlusion location, the pulling motion is stopped. The ring exerts suprasystolic pressure on the limb, thereby blocking arterial blood flow into the limb and thus acts as a
tourniquet. HemaClear
tourniquets are thin and sterile and therefore provide a large operative field. The authors report 2 cases of
pulmonary embolism after HemaClear
tourniquet application in patients with traumatic
injuries (fractures of the patella and tibial plateau).
Exsanguination applies mechanical stress that might dislodge a preexisting
deep venous thrombosis, leading to the serious complication of
pulmonary embolism. The authors want to increase awareness of this possible fatal complication during procedures performed on the lower limbs, when the HemaClear
tourniquet is used for
exsanguination of the affected limb. Careful consideration should be given to the use of HemaClear
tourniquets in high-risk patients and those with traumatic
injuries, especially when there has been a delay in surgery.