Bier Block Flashcards

1
Q

How does the bier block work?

A

Exsanguinate extremity by compression and occlude with pneumatic tourniquet

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2
Q

What types of cases is the bier blocked used in?

A

Hand/forearm

Can use in lower extremity in leg/foot

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3
Q

What is the limiting factor of the bier block?

A

Duration: 90-120m

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4
Q

At what point might the tourniquet become very painful to the patient?

A

After 30-45 minutes

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5
Q

What type of tourniquet must be used for a bier block?

A

Double wide cuff, two ports that are capable of having two different pressures

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6
Q

What type of IV should be placed in a patient receiving a bier block and where should it be placed?

A

IV 22g or less with the cannula as distal as possible on operative extremity

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7
Q

How can the provider aid in promoting venous drainage from the extremity?

A

Elevate the extremity

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8
Q

What is the purpose of the esmarch elastic bandage?

A

To exsanguinate all of the vascular tree of the extremity

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9
Q

What can occur if the esmarch bandage it wrapped too tightly around a ganglion cyst?

A

Could rupture the cyst

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10
Q

When placing the tourniquet on the patient, why is it important to know the difference between the two port sites?

A

One is proximal and one is distal, need to know this for inflation

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11
Q

In what order should the tourniquet be inflated when performing a bier block?

A

Distal cuff first then the proximal and then deflate the distal

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12
Q

What is an appropriate pressure to inflate the tourniquet to?

A

50-100mmHg greater than the systolic

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13
Q

What is the maximum amount to inflate the tourniquet in the upper and lower extremity?

A

Max 300 in arm

Max 400 in leg

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14
Q

Why do we deflate the distal cuff once the proximal has been inflated?

A

So LA can get under the distal cuff to anesthetize the area

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15
Q

What is the importance of tourniquet bounce?

A

Bounce indicates that the cuff is inflated

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16
Q

What type of LA should be used when performing a bier block?

A

Lidocaine 0.5% preservative free, WITHOUT vasoconstrictor

17
Q

How much volume should be injected for a bier block?

18
Q

What is the onset of a bier block?

A

About five minutes, may complain of hot, burning, pins and needles sensation

19
Q

What should be done to the catheter once LA is injected?

A

Should be taken out and firm pressure should be held on the site to prevent LA from bleeding out

20
Q

What is the goal of a bier block?

A

To exsanguinate all of the vascular system in the extremity and fill it with LA

21
Q

Why might the provider hold the wrist tightly while injecting the LA in a bier block?

A

Acts as a tourniquet to keep LA in area for longer period of time

22
Q

If a patient begins to complain about tourniquet pain, what can the provider do to relieve this?

A

Inflate the distal tourniquet where LA has anesthetized the area and then deflate the proximal cuff after confirming the distal is inflated

23
Q

Why must tourniquet time be greater than 20-30m?

A

Gives time for the LA to be metabolized, otherwise they will receive a large bolus IV and may experience LAST

24
Q

How should the provider proceed if the tourniquet is 20-40m long?

A

Release briefly then immediately reinflate, observe 1m for LAST
Repeat the process if no signs of LAST, deflate and remove

25
How should the provider proceed if the tourniquet time is greater than 40m?
Deflate slowly and observe for signs of toxicity
26
What are complication associated with a bier block?
Premature release of LA often associated with tourniquet failure --> May result in LAST Hematoma Engorgement of extremity Eccymoses and subcutaneous hemorrhage
27
How should the provider treat a patient that may be experiencing LAST?
Quickly isolate the extremity and support ventilation/circulation