When Should You Remove a Tourniquet?

Dietrich Easter

So you've learned how to apply a tourniquet, and now you're wondering: But when should I remove a tourniquet? Is it okay to ever remove a tourniquet? How do I remove a tourniquet? These are all good questions, and I'll give you the answers in this guide. 

When should you remove a tourniquet? Usually, never. Generally, you should not remove a tourniquet after you've placed it on someone's limb. Tourniquets can stay in place for several hours without causing significant damage. As long as you can transport the patient to a surgeon for definitive treatment (within a few hours), then the tourniquet should stay in place. 

Now, we did say usually never. There are some unusual instances where you might think about removing a tourniquet. Let's talk about them. 

(Photo: Bob Demers/UANews)


Times to Remove a Tourniquet (Very Rare!) 

While removing a tourniquet is a very rare occurrence, there are times when it might be necessary. Ensure that you have proper training before removing a tourniquet. Also, remember that assessing whether to remove a tourniquet can be difficult unless you have a basic understanding of how the human body functions.

Here are three times you might remove a tourniquet: 

  • It was placed incorrectly 
  • You don't think the person needed the tourniquet 
  • Extended tourniquet times (long rescue) 

  • Note: This article provides information only and should not replace medical advice. Making medical decisions about a tourniquet without proper training and authorization is not recommended. The medical field is complex and demands thorough training and research.

    (Photo: Jefferson Health)


    Tourniquet Placed Incorrectly 

    The first time you might consider removing a tourniquet is if the tourniquet has been placed incorrectly. If a tourniquet has been improperly placed, there's a high probability that it won't be effective at stopping the bleeding (and can even cause further harm!). 

    What are the times when a tourniquet might be placed incorrectly?

    First and foremost, avoid placing tourniquets directly over joints. Instead, position them over long bones like the femur in the thigh or the humerus in the upper arm. Therefore, if you come across a tourniquet positioned directly over the knee, ankle, or elbow, take the time to assess its safety.

    In some cases, if a tourniquet is positioned over a joint and isn't controlling a significant bleed, medical professionals may consider removing it, often after correctly placing a tourniquet in the appropriate location.

    Secondly, avoid placing tourniquets around the neck or head. While this is common sense, if you encounter someone with a tourniquet around their neck, promptly remove it. A tourniquet in this position could suffocate the person and cut off blood flow to the brain. 

    Thirdly, medical professionals may remove a tourniquet that isn't properly secured or was improperly installed. Why? Because if the tourniquet isn't effectively stopping a severe bleed, it's likely obstructing more than helping. In such cases, the tourniquet could be taken off or replaced with a functional one.

    Let's talk about several more times a tourniquet might be removed. 

    The Tourniquet Isn't Necessary 

    We talk a lot about being fast with the tourniquet. The outdated wisdom was to avoid a tourniquet at all costs and to only apply a tourniquet if all other methods fail to control the bleeding. However, this is NOT what is taught today. 

    Today, if you say to yourself "WOW, that's a lot of blood," then you should consider going straight to applying the tourniquet. 

    Now, let's get back to the point. 

    You might have seen a lot of blood or thought there was an arterial bleed, but upon further inspection, you realize that the tourniquet wasn't necessary, and you can apply a firm pressure dressing to control the bleed and then remove the tourniquet. 

    Estimating blood loss is notoriously difficult. And, while experience can certainly help, sometimes you'll want to err on the side of caution and apply the tourniquet. If, after inspecting the injury further, you find out that it wasn't as bad as you thought, you can often safely remove the tourniquet as long as you’ve controlled the bleeding another way. 

    Again, if you're not sure you can effectively control the bleeding using another method, it's best to leave the tourniquet in place until the patient can be evaluated by a physician. 

    Let's talk about one more situation one may consider removing a tourniquet. 

    The Tourniquet Has Been on for Many Hours (And no chance of rescue)

    The last time you might remove a tourniquet is if it's been on for extended periods. Choosing to remove a tourniquet after an extended time might be the trickiest decision of them all and requires authorization and medical training. Many things can go wrong when removing a tourniquet that's been in place for a while, and the decision isn't straightforward. 

    With that said, here's some of the reasoning behind the decision. 

    A patient can have a tourniquet in place for several hours without permanent damage to the limb; however, there is a threshold where the tourniquet will begin to cause permanent damage. If the person providing care to the patient feels that the bleeding can be controlled, they may opt to remove the tourniquet to save the limb. 

    Removing a tourniquet after it has been in place for many hours is not a simple process. Let's talk about it in more detail. 



    How to Remove a Tourniquet 

    If you run into an instance where you think you should remove a tourniquet, then there are a few steps you should consider to keep the patient safe. If you want, you can read this Stop the Bleed article on tourniquet removal

    Also, keep in mind that not all tourniquets function the same way. For example, the CAT tourniquet has a very different mechanism than the SAM tourniquet. Make sure you fully understand the tourniquet you're using before you attempt the application or removal of that tourniquet. 

    Steps to remove a tourniquet: 

  • Assess for contraindications 
  • Consult medical direction
  • Prepare to control bleeding 
  • Slowly remove the tourniquet while assessing the injury

  • See more details below. 

    Contraindications to Removing a Tourniquet

    The first step is to consider conditions under which you shouldn't remove a tourniquet - even if it had to be on for extended periods. 

    The first contraindication is if the patient is unstable and still in shock. If the patient doesn't seem to be doing well, then there's no reason to further complicate the situation by trying to remove the tourniquet. The chance of more blood loss is too dangerous, not to mention the worry about the release of toxins. 

    Second, if the tourniquet was applied to an amputated limb, then there should be no plans to remove it in the field. If there's no chance of saving the limb, then there's no reason to put the patient in any more danger. 

    Third, you should not remove a tourniquet if you don't have the training or resources to treat the side effects. When a tourniquet is in place for a long period of time, toxins can build up in the bloodstream, leading to big problems when the tourniquet is released. 

    After considering these contraindications (reasons not to remove the tourniquet), there are a few more steps. 


    Consult a Physician Before Removing a Tourniquet 

    If you can, always try your best to make contact with a physician. Even though they can't assess the patient, you will be able to relay information to them so they can assist in making treatment decisions. 

    It's also preferable that the physician be the one who will treat the patient, as they will have time to prepare for a complicated trauma patient.  

    Prepare to Control Bleeding After Tourniquet Removal 

    Before you start to remove a tourniquet, you want to have the supplies on hand to control bleeding. Make sure you have pressure dressings, extra tourniquets, and packing gauze to manage the bleeding. 

    Before you begin removing the tourniquet, it's important to make a final assessment about the possibility of rebleeding. You do not want to risk more blood loss!

    Slowly Remove the Tourniquet while Assessing for Bleeding 

    Once the decision has been made to remove the tourniquet, you should proceed with caution. Ensure you understand how the tourniquet works and then follow the steps backward during removal. 

    At each step, you should have a full visual of the injury. Watch for any signs of rebleeding as you loosen the tourniquet. If possible, monitor the patient for signs of heart problems and difficulty breathing. 

    Continue to reassess for bleeding constantly after you’ve removed the tourniquet. 

    Conclusion: Is it Okay to Remove a Tourniquet?

    Overall, the decision to remove a tourniquet is best left to a physician and a surgical team. However, there are some instances where tourniquets are removed in the field. A few instances include when the tourniquet was placed improperly when the tourniquet wasn't needed at all, and when the patient had a vastly extended rescue. 

    Remember, you should not attempt to remove a tourniquet unless you are trained and authorized to do so. If you're curious to learn more about tourniquets, read this guide on how many tourniquets you should carry.