Which is an indication for replacement of a tourniquet (TQ)?

• A. Annotate time
• B. >2 hours to surgery
• C. Apply replacement tourniquet 2-3 inches above site
• D. Slowly release TQ over 1 minute

Answer: (B)

Prolonged limb ischemia risk drives the need to replace a tourniquet. When the clock shows that definitive care is more than about two hours away, you replace the tourniquet with a fresh one to maintain hemorrhage control while reducing the chance of tissue injury from a single long application. The time factor is what makes replacement necessary, not just documentation or the technique of placement.

Annotating the time is about keeping a record, not deciding to replace. Describing where to place a replacement tourniquet is about how to perform the replacement, not when to do it. Releasing the tourniquet slowly is a management step for reperfusion, not a trigger to replace the device.