Enhancing Patient Outcomes with Sequential Compression Device Therapy

By Moore, Cathy; Nichols-Willey, Jeanne et al. | American Nurse Today, August 2013 | Go to article overview

Enhancing Patient Outcomes with Sequential Compression Device Therapy


Moore, Cathy, Nichols-Willey, Jeanne, Orlosky-Novack, Jennifer, American Nurse Today


Patients continue to have poor outcomes after suffering blood clots in the legs or arms, despite physician orders for therapy with sequential compression devices (SCDs). As a nurse, you can play a pivotal role in improving outcomes by evaluating patients at risk for deep vein thrombosis (DVT) and by using SCD properly and safely to prevent complications of thrombi and pulmonary embolism (PE). The Joint Commission now uses the term venous thromboembolism (VTE) to encompass both DVT and PE. (See Understanding venous thromboembolism.)

//START MARG A//

Understanding venous thromboembolism

More than 2.5 million people are diagnosed with deep vein thrombosis (DVT) each year. DVT results from clot formation in a deep vein, usually in the leg. It can lead to pulmonary embolism (PE), in which the clot breaks loose, travels through the bloodstream to the lungs, and lodges there. In the lung, the clot inhibits blood flow and can damage part of the lung or even lead to death. Venous thromboembolism (VTE) is the umbrella term for DVT and PE.

Incidence of upper-extremity DVT has risen from increasing use of indwelling venous access catheters, permanent pacemakers, and internal cardiac defibrillators. With today's shorter hospital stays and more same-day surgeries, patients with DVT may lack symptoms while hospitalized or may not develop symptoms until after discharge. Mortality for lower-extremity DVT ranges from 13% to 21%; for upper-extremity DVT, it may be as high as 48%. With PE, mortality can be as high as 25%; the condition causes roughly 10% to 25% of hospital deaths.

VTE pathophysiology

The deep veins in the legs return venous blood to the right atrium and lungs. Contractions of leg muscles and one-way venous valves push blood forward from the feet to the heart's right atrium. This occurs because the venous system is a low-pressure system; muscles act as pumps to increase the velocity of returning blood, forcing blood upward to the heart. One-way venous valves open in response to pressure of the blood to prevent backward flow and blood pooling in the venous system. DVT risk increases with damage or trauma to the venous system or the lungs and with patient immobility.

[ILLUSTRATION OMITTED]

//END MARG A//

Promoting better outcomes

To enhance patient outcomes, clinicians should focus on VTE prevention. This is best achieved through risk stratification, identification of at-risk patients, and use of VTE prophylaxis (pharmacologic, mechanical, or a combination). Hospital patients are at higher risk for VTE because of their limited mobility, active disease processes, and comorbidities. Those with cancer, trauma, surgery, and obstetric diagnoses have the highest risk for VTE complications.

Mechanical devices, such as SCDs, are the first choice for VTE prophylaxis. These methods are as efficacious and reduce risk as much as pharmacologic methods, without causing bleeding complications. (Be aware, though, that SCD therapy is contraindicated in DVT, compartment syndrome, extremity deformity, and an open infected wound of the extremity.)

Traditionally, physicians' orders for SCD or other types of mechanical compression therapy have lacked all the components needed to provide adequate therapy. These orders should specify:

* whether to use bilateral or single sleeves

* whether to use sleeves on the lower or upper extremities

* whether to use knee-length or thigh-length sleeves

* duration of continuous SCD therapy

* criteria for discontinuing SCD

* instructions for sleeve removal every 8 hours to assess skin integrity and neurovascular status of the extremity. Neurovascular assessment should include checking for the "5 Ps" of ischemia--pain, pulse, pallor, paresthesia, and paralysis.

VTE risk assessment

On arrival at the hospital, adult medical and surgical patients should undergo VTE risk assessment by a physician or a licensed independent practitioner (LIP).

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Enhancing Patient Outcomes with Sequential Compression Device Therapy
Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.