DVT sleeves and technology

stevierae · Apr 11, 2005

Huh, I've always heard sequential compression devices are better, but I can't say I've done any particular research on it or seen any studies. I do think that if one is going to put SCDs on a patient that they should have anti-embolic stockings underneath. Again, I don't have any particular research; that's just my personal belief, and the way I do it as a nurse. I have seen people put SCDs on with nothing under them or with stockinette under them--what's the point? I think the TEDs give them an extra measure of anti-embolic protection than just the SCDs alone would. I could be totally off base--it just seems to make sense.

I think post-op patients should be on Lovenox at least until ambulatory, too, and I think they should be ambulatory ASAP--or at least dangling their legs over the edge of the bed at intervals, and moving them around. Also, I can never figure out why some people remove the SCDs once the operation is over--to me, post-op is just as critical a time. Leave them on for a day or 2--at least until they are ambulatory ad lib---sure can't hurt.

nurselily3 · Apr 17, 2005

In our merged hospital system, we are in a quandry about DVT therapy with the question being sequential vs. uniform compression. Each vendor is representing his technology as effective. I would like input from all you nurses about how your institution decided on which DVT sleeve and system to use and the clinical issues you see with the effects of your decision. Thanks.

We use SCD's on our patiens without TED hose. They stay on the patient until they become ambulatory. There is some controversy about how much protection you get from just the lower leg SCD's vs the ones that go up to the thigh. Our patients all get 5000u subq heparin bid as well. I personally like SCD's cause ours have a cooling button if the get to warm on the patient.

Marie_LPN, RN, LPN, RN · Apr 17, 2005

Depends on what the surgeon writes in their orders. Sometimes the TED hose at used with the SCDs, sometimes just the SCDs. Sometimes the booties or the lower leg ones, sometimes the thigh high ones.

We have one doc that reported a nurse for putting TEDs on under the SCDs, because he didn't order the TEDs.

suzanne4, RN · Apr 17, 2005

Foot pumps made by Kendall provide uniform pressure to the bottom of the foot every so many seconds. These are grea for patients that are too large for the SCD sleeves, as well as during orthopedic procedures because you can set just one foot. They each have their own control.

SCDs can actually be used with or without anti-embolic stockings. It is nurse and physician choice................Some patients do not tolerate the stockings so you can use just the sleeve...........again patient size also comes into play. Ace wraps can also be used in place of anti-embolic stockings due to size limitations.......

Also depends on what your facility has available. I just know that I will not do a case without some protection to the lower extremities....... :)

stevierae · Apr 17, 2005

Depends on what the surgeon writes in their orders. Sometimes the TED hose at used with the SCDs, sometimes just the SCDs. Sometimes the booties or the lower leg ones, sometimes the thigh high ones.
We have one doc that reported a nurse for putting TEDs on under the SCDs, because he didn't order the TEDs.

I think of it as a nursing decision. However, I know some physicians have private pay patients or even insured patients who carefully scrutinize every detail of their bills and question what they feel are unnecessary charges--those type of patients might object to the TEDS--still, they are theirs to keep and use at home, and they might come in handy one day. (Hospital charges can, indeed, be outrageous--I remember one of our docs back in the '80s stopped using impervious stockinette, as a single stockinette was billed at $35! A patient pointed this out to him. I'm sure it's more today.

I just feel better using TEDS under SCDs--not only for the extra protection (if the patient takes the SCDs off while stilll confined to bed, as they tend to do) and also because you never know how well the sleeves are cleaned when they are returned to central supply in preparation for use on another patient. One hopes they are cleaned and terminally sterilized between patients, but sometimes I wonder.

Marie_LPN, RN, LPN, RN · Apr 17, 2005

We throw our sleeves out, we're told to throw them out, if they're not being sent to the floor with the pt.

Sterile supply isn't allowed to process them, we get new ones from pack supply.

suzanne4, RN · Apr 18, 2005

All of the sleeves that we use are single-use only.........no wonder that you like to use TEDS with yours, Steph. :)

stevierae · Apr 18, 2005

All of the sleeves that we use are single-use only.........no wonder that you like to use TEDS with yours, Steph. :)

Yeah, ours probably should be thrown out---but HMOs try to save a buck wherever they can. Probably costs more to re-process them than it would to start with brand new ones for each and every patient. :uhoh3:

One thing I think is wrong---EVERBODY gets charged as if they are brand new, when, in fact, they are not--they have been used, over and over and over--just (supposedly) cleaned and gas sterilized between patients. However, the answer you hear if you object is, "What do YOU care? It's not like the money is coming out of YOUR pocket! The health plan is paying for it."

Yeah--right... the health plan is paying for it---but that means WE, who are also health plan members, are paying for it, as evidenced by ever skyrocketing premiums.....

Oh, well.... I guess management knows best--just ask 'em; they ALWAYS know best... :rotfl:

CEN35 · Apr 19, 2005

here's the lowdown on these things.

The physical action of the squeezing effect has no bearing on DVT formation. What it does do, and per one of our vascualr surgeons via research article.

By intermittently squeezing the leg or feet, it artificially makes the body think it's using it's muscles.

The increased incidence of clots while labile, or sedentary life style, bedbound etc, is d/t the lack of muscle use.

By working you muscles, or making your body think it's using them, your body releases fibrolynisis (itic) (sp) factors, that help prevent the blood from clotting. Allegedly per this research, one side on only, has the same effect as two sides. They suspect, it's not quite as effective though. They claim it's a generalized reaction, for the entire body not just for the legs.

So, I don't think it really makes a difference?

rick

mcmike55 · Apr 21, 2005

At my hospital, we, like most of you, use SCD's and TED hose in combination. I'm not sure I've ever see another type of compression device. The other sounds like it squeezes the entire leg and then lets go. That just doesn't seem right to me. I like the SCD's, they at least look like they are pushing venous blood the right way.

We also use the foot pads on pt's that SCD's don't work on for what-ever reason. They are supposed to replicate the motion of your foot when you walk.

I also don't remember any recent studies about DVT therapy, but it seems to me, two different modes of treatment (TEDS & SCD'S) are better than one alone. Cheap and effective, easy to use...don't see a problem here!! :chuckle

Some of our GYN docs add a little more, 5 K units of SQ heparin in the holding area.

Mike

stevierae · Apr 22, 2005

At my hospital, we, like most of you, use SCD's and TED hose in combination. I'm not sure I've ever see another type of compression device. The other sounds like it squeezes the entire leg and then lets go. That just doesn't seem right to me. I like the SCD's, they at least look like they are pushing venous blood the right way.
We also use the foot pads on pt's that SCD's don't work on for what-ever reason. They are supposed to replicate the motion of your foot when you walk.
I also don't remember any recent studies about DVT therapy, but it seems to me, two different modes of treatment (TEDS & SCD'S) are better than one alone. Cheap and effective, easy to use...don't see a problem here!! :chuckle
Some of our GYN docs add a little more, 5 K units of SQ heparin in the holding area.
Mike

mcmike, do you remember the old Venodynes? Used them in the '90s? Maybe some hospitals still use them? The sleeves are plastic or some other sort of non-latex material that is waterproof. They are non-disposable. They are an example of non-sequential compression devices---they squeeze the entire calf, (or calf and thigh,) relax, then repeat the sequence.

If you don't use stockinette or, preferably, TEDs under them, the patient sweats horribly, (the material, whatever it is, does not seem to breathe) and can even experience skin breakdown.