Tourniquets

Product Description

This is a Safer Injecting product.

Tourniquets or “ties” are used to “tie off” and restrict venous blood flow causing the veins to bulge out and become accessible to facilitate injection.

OHRDP provides thin, pliable, latex-free, non-porous, quick-release tourniquets. These single-person tourniquets are less likely to cause trauma to the veins than other commonly used ties such as belts, bandanas, condoms, wire, rope and shoelaces1.

Best Practice

Best Practice:

Use a single-person tourniquet for each injection to reduce transmission of HIV, hepatitis C (HCV) and other pathogens. Tourniquets contaminated with bacteria can cause abscesses (e.g., MRSA). Makeshift equipment can cause trauma to veins and impair blood circulation.
  • Provide thin, pliable, easy to release, non-latex tourniquets with non-porous surfaces in the quantities requested by clients with no limit on the number of tourniquets provided per client, per visit
  • Offer tourniquets with each needle provided
  • Provide pre-packaged safer injection kits (needles, syringes, cookers, filters, sterile water for injection, alcohol swabs, tourniquets and ascorbic acid, if necessary) and also individual safer injection supplies concurrently
  • Dispose of used tourniquets and other injection equipment in accordance with local regulations for biomedical waste
  • Educate clients about the risks of bacterial contamination and HIV- and HCV-related risks associated with the re-use of tourniquets, the risk of tissue and vein damage and blood circulation impairment if a clean, quick-release tourniquet is not used, and the correct single-person use of tourniquets
  • Educate clients about the correct disposal of used tourniquets, according to local regulations
  • Tourniquets should be single person, single use only and used only if they are really needed. Many injectors, at least early in their injecting lives, should be able to access veins without using a tourniquet
  • Discourage the use of ropes, belts, bandanas and wire, which can lead to severe trauma to the skin, veins and increase the risk of overdose
  • Various techniques can be used to help superficial veins become more accessible, including:
    • Clenching and re-clenching the fist
    • Applying a hot compress to the vein
    • 'Windmilling' the arm
    • Any vigorous exercise (push-ups)
    • Letting the limb hang down
    • Slapping the vein
    • Bathing the arm in warm water (If the client is injecting depressants (opiates) it is important to point out the dangers of injecting in a bath as a period of unconsciousness could result in drowning)
  • A tourniquet is considered unclean and needs to be replaced when: there is visible dirt and or blood on it; it has ever been used by someone else; and if there is a loss of elasticity
  • It is recommended to estimate approximately 1,000 needles per person, per year, so a Needle Syringe Program should estimate 1000 tourniquets per person per year
  • It is important to rotate inventory to ensure that the shelf life of the product does not expire prior to distribution to clients
  • Tourniquets, like other injecting equipment, can facilitate the transmission of blood-borne pathogens such as HIV and HCV. Participant observation studies of injection drug users in Australia and Scotland have shown that tourniquets may be another potential source of exposure to blood-borne viruses when shared
  • Tourniquets can also carry the bacterium Staphylococcus, which is the organism responsible for the formation of abscesses
  • Remind clients to remove the tourniquets as soon as possible because leaving it on will prevent their circulation from flowing and can cause a limb to turn blue and lose sensation and eventually can cause gangrene
  • If a tourniquet is not loosened prior to injection, excess pressure has to be used to get the solution into the vein and can lead to leakage of the drug into the tissue or can cause the vein to rupture. If a client is complaining of "missing hits", check that they are releasing the tourniquet before injecting

Sources & Resources

  1. Strike C, Hopkins S, Watson T, Gohil H, Young S, Buxton J et al. Best practice recommendations for harm reduction programs: needle and syringe distribution, other injecting equipment distribution, safer crack kit distribution (interim version). 2012
  2. Crofts N, Aitken CK & Kaldor JM. "The Force of numbers: why hepatitis C is spreading among Australian injecting drug users while HIV is not". Med J Aus 1999; 170:220-1
  3. Taylor A, Fleming A, Rutherford J & Goldberg D., Examining the injecting practices of injecting drug users in Scotland. Edinburgh: Effective Interventions Unit, Scottish Executive Drug Misuse Research Programme, University of Paisley, 2004
  4. Strike C, Leonard L, Millson M, Anstice S, Berkeley N, Medd E. Ontario Needle Exchange Programs: Best Practices Recommendations. Toronto: Ontario Needle Exchange Coordinating Committee 2006
  5. Lavingne P. Memo: Provision of tourniquets to injection drug users through the Site Program. Ottawa Public Health, December 23, 2004