DVT Prophylaxis in critical care

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Specializes in Med/Surg; Critical Care/ ED.

I can't remember where, but I read that ted/job stockings are falling out of favor and physicians are starting to use SCDs only. I am wondering if this is really happening anywhere, especially in critical and if so, what your protocols are. Do you always use lmw heparin unless indicated other wise?

If this is truly the case and the stockings are no longer indicated, I'd like to start doing research on it for my unit.

Thanks

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Specializes in ACHPN.
I can't remember where, but I read that ted/job stockings are falling out of favor and physicians are starting to use SCDs only. I am wondering if this is really happening anywhere, especially in critical and if so, what your protocols are. Do you always use lmw heparin unless indicated other wise?

If this is truly the case and the stockings are no longer indicated, I'd like to start doing research on it for my unit.

Thanks

Our DVT prevention protocol does not allow for use of TEDS. We use SCDs and either 5000 units hep q 12hr or lovenox 40mg daily (sometimes use 30 mg q 12 hrs). When anticoag is contraindicated, we just use SCDs. It seems they should change the label of TEDS as anitembolic stockings, if in fact, they aren't antiembolic.

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Specializes in Med/Surg; Critical Care/ ED.

I guess that's what I'm questioning. When did teds stop being considering antiembolic and why are they not considered antiembolic?

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I can't remember where, but I read that ted/job stockings are falling out of favor and physicians are starting to use SCDs only. I am wondering if this is really happening anywhere, especially in critical and if so, what your protocols are. Do you always use lmw heparin unless indicated other wise?

If this is truly the case and the stockings are no longer indicated, I'd like to start doing research on it for my unit.

Thanks

We generally use SCD's and/or Lovenox, unless the pt is already heparinized or on coumadin-in our ACCU

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Specializes in ACHPN.

I haven't seen any literature, but I can make a couple of educated guesses. SCDs offer intermittent masssaging while TEDS are continuouse compression. I wonder if the SCDs are more effective at circulating the blood. Also, I have varicose veins and use to wear TED-like hose to work. By the end of my 12 hours, the top of the stocking had embedded itself into my popliteal area, leaving a huge bulge. I think the same could happen to a pt, therefore increasing the risk of a DVT. And forget thigh highs, they are so unrealistic ( nearly impossible to get on, and easily soiled!!!)

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Specializes in LDRP.

We have DVT screening forms we use on all adult inpatients, on admission. It's a algorythm to determine their risk, asks if htey are already on lovenox/heparin, etc, and at the end, you come to what option you should use as prophylaxis on said pt. then, you put a sticker on the dr's orders section saying "this pt meets dvt prophylaxis criteria...." adn the doc checks a box for "administer treatment as directed by form" or "do not"

and yes, scd's are frequently used.

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SCD's need to be used in conjunction with TED's to be effective. SCD's help circulate blood with a massaging action but do nothing to increase the competency of the valves in the veins. TED's increase the competency of the valves and prevent pooling of blood in distended veins but are not as effective in aiding circulation as SCD's. Without TED's, SCD's can actually make the risk of DVT worse in some patients. Cost is the only reason not to use TED's and if I had to make a choice, I would choose TED's over SCD's.

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Specializes in Hospice, Critical Care.

Our critical care docs use SCDs or heparin/lovenox. Never order TEDS. Even with the SCDs, though, they usually say the "horse is already out of the barn" by the time they are applied.

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Specializes in cardiac/critical care/ informatics.

We routinely use scd's and lovenox 40mg sq we rarley use teds except on our post cabg's and they don't usually have scd on.

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Specializes in Med/Surg; Critical Care/ ED.

Thanks so much for all your responses. I'm wondering what those of you who aren't using teds w/ scds think about what SFCardiacRN said. Will that make you rethink your protocols?

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The reality of the deal is getting the TEDS to fit properly, which is difficult with an alert, otherwise healthy pt; trying to put them on a little (or BIG) old lady with fragile skin and joint pain is dang near impossible. Oftentimes they roll at the top, and end up cutting into their skin or impeding circulation at the thigh. There are, what, three or four different adult sizes of TEDs? That's what is carried on our floor. And yet people's legs and bodies come in so many different shapes and sizes....

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I've heard (but not done any research myself on this topic) that one or the other is sufficient, that you do not need both SCDs and TED hose. At our hosital, it seems to be simply the doctors preference which therapy the pts get (TEDs or SCDs) and which med is used (heparin vs lovenox). Our intensivists generally only use heparin, I think in part because as quickly as ICU pts change, if we start having bleeding issues, we can quickly get lab values to inform us about heparin, but with lovenox, there isn't a lab test you can do. It's an interesting question...I'll ask our intensivists on it specifically next time I work.

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