Characters can use items at any time, within the constraints of what is written on the item card, including in the middle of a card ability.

However, if an item affects an attack (e.g. adds a bonus, an effect, advantage, or disadvantage), it has to be used before an attack modifier is drawn.

If an effect is added to an attack, it functions exactly as if it had been written on the action card being used for the attack.

There is no limit to the number of items a character can use on their turn or even during a specific ability.

Any instance of applying the effects of an item card to a situation is considered a use.

Like persistent abilities, an item with multiple use circles must be used when the situation applies.

This symbol means the item is spent after use, which is denoted by rotating the card to its side.

Spent cards can only be refreshed when a character performs a long rest.

This symbol means the item is consumed after use, which is shown by flipping the card facedown.

Consumed cards can only be refreshed during a scenario by specific abilities.

All items are refreshed between scenarios. No item can be permanently consumed.

If a card depicts neither of these symbols, there are no restrictions on the number of times it can be used during a scenario, other than what is written in the text of the card.