Why do SCDs need to be on the patient prior to anesthesia induction?

[Chocolate39]

Hi everyone!

During my nursing internship I was taught that SCDs should be on prior to anesthesia putting the patient to sleep. I cannot remember the rational behind this, but it had something to do with excitability and maybe higher chance of a DVT during that time? I tried to find evidence based articles around this topic, but haven't had much luck. Instead I have found research that suggests the opposite, SCD placement can happen at any time during surgery...

[Ruby Vee, BSN]

It seems that if you put them on before induction, the patient will be able to cooperate with placement and tell you if they're rubbing anywhere, causing pain or otherwise uncomfortable. But I'm just an ICU nurse, so perhaps someone from the peri-operative team will chime in.

[Rose_Queen, BSN, MSN, RN]

General anesthesia has been shown to decrease lower-limb venous return profoundly, and Kiudelis et al16 stated that 50% of anesthetized patients develop some degree of venous stasis intraoperatively because of anesthetic vasodilatation effects similar to those produced by 10 to 14 days of bed rest, which affect the clotting cascade.

Placing the SCDs and starting them after the patient is anesthetized may mean having to play catch up instead of being a true prophylactic measure.

http://www.aornjournal.org/article/S0001-2092(15)00191-X/fulltext

[LJOHRrn]

Gases and meds used for induction drop blood pressure. SCDs work by keeping blood pressure up while legs are neutral, dependent, and not greatly perfused and prevent clots.

[chare]

Placing the SCDs and starting them after the patient is anesthetized may mean having to play catch up instead of being a true prophylactic measure.

http://www.aornjournal.org/article/S0001-2092(15)00191-X/fulltext

Your link appears broken,; which volume and issue is this article in?

[chare]

Gases and meds used for induction drop blood pressure. SCDs work by keeping blood pressure up while legs are neutral, dependent, and not greatly perfused and prevent clots.

How exactly do SCDs support or maintain blood pressure?

[Rose_Queen, BSN, MSN, RN]

Your link appears broken,; which volume and issue is this article in?

AORN switched publishers (and thus websites) which is why the link no longer works. Here's the updated one.

https://aornjournal.onlinelibrary.wiley.com/doi/pdf/10.1016/j.aorn.2015.02.011

[bd2rn]

How exactly do SCDs support or maintain blood pressure?

I don't believe scds DO support blood pressure. The encourage venous return/keep blood from pooling in the VEINS. B/p of course refers to arterial pressure.

[chare]

I don't believe scds DO support blood pressure. The encourage venous return/keep blood from pooling in the VEINS. B/p of course refers to arterial pressure.

Thank you. My question was directed to LJOHRrn's in which he or she stated "SCDs work by keeping blood pressure up while legs are neutral, dependent, and not greatly perfused and prevent clots."

[offlabel]

I don't believe scds DO support blood pressure. The encourage venous return/keep blood from pooling in the VEINS. B/p of course refers to arterial pressure.

Not too much arterial pressure without venous return...that said, SCD's don't contribute to any significant degree.

[offlabel]

I don't believe that there is any credible evidence that it makes a difference one way or the other with regard to DVTs if they're started after the induction. Like someone mentioned, checking for pinch points is possible when the patient is awake and if you start them up at the same time every time, you're not likely to forget.

It isn't as if blood magically begins to pool and clot in the immediate post induction period. It's one of those things that became standard and the speculation as to why came afterward.