HemaClear® Extra Extra Large

Measure the limb circumference at the occlusion location using the Measuring Tape provided, which is color-coded according to circumference, in order to select the correct HemaClear® Model (Small, Medium, Large, Extra-Large). Verify that the circumference corresponds to the device range according to the Selection Guide.
– For upper extremity procedures, the occlusion location should be 10 cm above the wrist for hand procedures, or mid-upper arm (or higher) for forearm, elbow, and distal humerus procedures.
– For lower extremity procedures, the occlusion location should be 5-15 cm above the lateral malleolus (below the calf muscles) for foot procedures, or mid or upper thigh for ankle, lower leg, knee, or distal femur procedures.
Measure the distance from the tips of the fingers/toes to the occlusion location. Verify that the distance does not exceed the device’s maximal length according to the Selection Guide.
Verify that the patient’s systolic blood pressure does not exceed the limit specified in the Selection Guide for the selected HemaClear® Model.
Refer to the appropriate color-coded Pressure Table for device pressure at skin level.

Using a sterile technique, open the outer envelope of the device and drop it onto the sterile field, with inner envelope intact. Use a sterile technique to remove the device from within the inner envelope. Keep the Protective Card for the end of the procedure to protect the skin when the silicone ring is cut, in keeping with instructions regarding use of the Protective Card.

If the patient is awake, explain the application procedure and warn about possible ring pressure discomfort. Sedation and/or analgesia may be used. Disinfect the limb according to the type of procedure performed. Apply sterile drapes so that they overlap the edge of the disinfected region.
Insert the toes into the orifice of the device with the handles facing away from the patient. Ensure that all the toes are inserted into the circumference of the ring. Position the device on the toes so that one handle is aligned with the bottom (sole) of the foot, and the other handle is aligned with the top of the foot. Stand proximally to the patient’s foot, so that when pulling the device straps proximally on the patient’s leg, you are pulling towards your body. Have an assistant stabilize the foot and ankle of the patient.

Firmly grab the two plastic handles using the colored straps, and pull the handles first along the foot and then proximally along the leg. To roll HemaClear® over the heel, apply more force to the bottom handle, using it as a hinge. Once over the heel, continue pulling on the handles until HemaClear® reaches the desired occlusion location.
Occlusion locations: A) On the calf (5-15 cm above the medial malleolus, below the calf muscle) or B) On the thigh (at or above the mid-thigh).
NOTE: HemaClear® should be placed within the sterile field on the limb over the edge of the sterile drapes.

Once HemaClear® is in place, the colored straps can either be wrapped around the limb, distal to the HemaClear® ring or cut off.

xpose the incision site by pulling the stockinet up, removing it, or cutting a window in the fabric.
NOTE: To minimize lint, dampen the fabric with sterile water or saline before cutting it.

Tourniquet Time begins as soon as the HemaClear® is in place. Tourniquet Time ends when the HemaClear® is removed.
When the procedure is over, insert the Protective Card under the ring from its distal side by pulling one of the straps and cutting the ring with a scalpel. Use scissors to cut and remove the remaining stockinet. Blood flow to the limb will resume.