LIMB EXSANGUINATION/TOURNIQUET IN
ORTHOPEDIC SURGERY and EMERGENCY MEDICINE

 Technical Information-How it Works?  

The S-MART™ consists of a silicone ring wrapped in a
stockinette bandage with 2 pull handles.
The physician places the ring on the fingers or toes and
pulls the 2 straps proximally. The silicone ring rolls up the
limb and the stockinette bandage unfolds onto the limb. 

When the silicone ring reaches the required blood flow occlusion position, the pulling motion is stopped. The ring exerts pressure on the limb at this position, preventing any blood flow into the limb and thus performing the occlusion.

During the motion on the limb, the stockinette bandage unfolds onto the limb, covering it entirely up to occlusion location and thus placing the stockinette on the surgical field.

TThe duration of the entire application from fingers or toes to the occlusion location is less than 12 seconds. The S-MART™ exsanguinates, occludes and places a sterile stockinette over the surgical field in under 12 seconds.

Advantages of the S-MART™:
The S-MART™ performs three functions in one fast and simple method: exsanguination, occlusion and placement of a sterile stockinette. The S-MART™ outperforms the current methods in speed, reliability and consistency of the pressure applied to the limb.
The S-MART™ is a sterile, single-use product. The S-MART™ ensures patient protection from cross contamination and eliminates time consuming and costly postoperative clean-up.
The S-MART™ is a latex free product. It can be safely used in the operating room environment eliminating the concern regarding any latex-related problems.

Exsanguination
The current methods, limb elevation or the Esmarch bandage method, are time-consuming (limb elevation: up to 5 minutes, Esmarch wrapping: 2-4 minutes).
The effectiveness of the Esmarch bandage is strongly dependent on the pressure applied during the wrapping process and the technique used by the surgeon. The physician has no feedback or quantitative indicators of the pressure applied to the patient's limb.
The effectiveness of both these methods in removing blood from the limb is limited. Published reports show the limb elevation method removes less than half (45%) of the blood from the limb and the Esmarch bandage technique removes 60% of the blood. Clinical results with the S-MART™ have shown exsanguination of 90%.

S-MART™ exsanguination advantages are:

• FASTER: the application time is less than 12 seconds
• CONSISTENT: the pressure applied on the limb is independent of the application technique
• BETTER: higher percentage of blood removal

Occlusion
The current method of arterial occlusion is based on the use of the pneumatic tourniquet. While tourniquets are the accepted gold standard, they are not a favorite of the physicians. Tourniquets are prone to various operational and reliability problems. There are numerous reports in the literature documenting patient injury as a result of malfunctioning tourniquets, particularly the application of excess pressure to the limb. Other concerns are:

• Gas tube occlusion or release
• Inadvertent cuff release
• Non-calibrated pressure levels

The pneumatic tourniquet cuff is placed on the patient's limb, outside the sterile field. In many operations the cuffs are soiled with the patient's blood, thus creating problems of cross-contamination. Cleaning and/or sterilization of the cuffs is a time consuming and costly postoperative procedure that can impair the lifetime and functionality of the cuffs and is not always done.

Since the S-MART™ is a sterile product and remains in the sterile field during the operation, the surgeon applies and removes the S-MART™ without the need for any non-sterile OR personnel. The pneumatic tourniquet is a non-sterile device. A non-sterile nurse/technician is required for the cuff placement and removal and also for the activation and de-activation of the pressure to cuff during the operation. By providing the surgeon with a sterile product, the S-MART™ gives the surgeon complete control over the course of the operation without the need for help from a non-sterile OR staff member.

The pneumatic tourniquet requires gas tubing and electrical connections. These connections both clutter the operating room and are a source of potential liability problems if an OR personnel trips on the tubing or cables.

The S-MART™ silicone ring applies pressure on the limb, thus occluding the blood flow .Since pressurized gas is not used ,there is no need to transport and regulate the gas.

The S-MART™ consists of one compact and efficient unit and is completely contained on the patient's limb. There is no need for tube connections from the patient's limb to a remote location or for any electrical connections and no cluttering of the OR with tubes and cables.

S-MART™ occlusion advantages are:

• SAFE - no inadvertent or accidental pressure loss or access pressure
• STERILE - no cross-contamination and no non-sterile OR personnel
• LATEX-FREE - no problem of latex sensitivity
• COMPACT - self-contained on the patient
  

Sterile Field Stockinette
S-MART™ includes a single-ply stockinette, matching the standard stockinette in use today. The stockinette unfolds on the patient's limb as the S-MART™ moves proximally to the occlusion location. The stockinette placement is part of the exsanguination process and no extra time is required for its placement.

In summary, the S-MART™ provides a 3-in-1 functionality for quick, reliable, sterile and latex-free blood flow management