PHLEBOTOMY

• Dry phlebotomy or rotating rotating tourniquets intend to allow pooling of blood in the lower extremities, thereby reducing preload.
• Three extremities are occluded at a time.
• Rotate the touniquets clockwise every 15 minutes.
• Each extremity is occluded for a maximum of 45 minutes.
• If BP compression cuff is used as tourniquet, inflate up to slightly above diastolic pressure (10 to 40 mmHg). This allows occlusion of venous return but arterial flow remains patent.
• Perform neurovascular check distal to the tourniquet application:

1. Skin color.
2. Skin temperature.
   
3. Presence of pulse.
4. presence of numbness or tingling.

• If tourniquet application is too tight, tissue ischemia may occur.
• Assess for signs and symptoms of thrombosis and embolism.
• Remove tourniquet one at a time every 15 minutes.