SCD'S with history of DVT

[sirwinston1]

I know scd's are contraindicated in patients with a CURRENT dvt, but what about for patients with a HISTORY of dvt?

I would think because the patient had a history of dvt (> 6 months ago), they would be at a higher risk of developing a dvt, thus, resulting in the definite use of scd's. Can anyone provide insight?

[Double Dunker]

I think it would also depend on whether the patient is on pharmacological prophylaxis and how much they ambulate.

[BeatsPerMinute, BSN, RN]

if a patient has a hx of DVT we get an order to venous doppler ultrasound the legs before applying scds

[MunoRN, RN]

There actually not much agreement that SCD's are contraindicated in a current DVT, so it would sort of depend on what view the ordering MD takes on the subject.

It used to be thought that patients with DVT's should be on bedrest, this was not based on any actual evidence. Multiple studies have shown that bedrest does not prevent complications in the treatment of DVT and actually does the opposite, so as it turns out patients with DVT should not only be allowed to ambulate, but should be encouraged to do so.

Since the basic purpose of SCD's is to mimic the effect of walking on venous flow, they were considered contraindicated with current DVT when we used to think that ambulation was contraindicated. The best way to treat DVT is to prevent it, and patients a hx of DVT are at an established risk for developing a new DVT and therefore are the most important patients to either ambulate regularly or apply SCD's to.

[SarahRN2013]

There actually not much agreement that SCD's are contraindicated in a current DVT, so it would sort of depend on what view the ordering MD takes on the subject.

Agreed. Recently some of our physicians have started ordering SCDs for patients currently experiencing a DVT -- and they actually mean for the nurses to apply them (whereas some physicians order them (out of habit, I suppose) and do not want them applied to a patient who has a DVT). It's gotten to where if the off-going RN can't tell me if someone has spoken to the physician to clarify the order, I have to call the ordering provider because I don't which it is. (And of course I follwo-up by putting in a physician to nurse order so everyone will know that they should be applied, or discontinue the order if they should not be applied).

[PCnurse88]

Most of the time we don't use SCDs in patients with blood clots or with a history of clots because they are already on blood thinners. My hospital exclusively uses heparin drips for a diagnosis of DVT/PE unless there's a heparin allergy or HIT so no mechanical DVT prophylaxis. A large population of our patients are also already on coumadin, lovenox, or xarelta for various reasons. Maybe because we have a cards clinic in-house so we get a lot of afibbers? Our docs order SCDs more for management of swelling than DVT prophylaxis.