By Lynn Razzano RN, MSN, ONCC
Graduated compression stockings and other mechanical compression devices have been shown not to be effective unless they are worn at least 18- 20 hours a day.
Mechanical compression devices exert their therapeutic effects by limiting venous stasis and enhancing fibrinolysis.
- Research has shown patients who received intermittent pneumatic calf compression preserved the normal thrombin/plasmin ratio in blood samples obtained vs. those not receiving pneumatic compression. This demonstrates that intermittent pneumatic calf compression helps prevent hypercoaguable states that contribute to development of VTE.
- Mechanical compression devices increase venous blood flow velocity and have been shown to increase the amount Tissue Plasminogen Activator -tPA. (Tissue plasminogen activator is a protein involved in the breakdown of blood clots. It is found on endothelial cells, the cells that line the blood vessels. As an enzyme, it catalyzes the conversion of plasminogen to plasmin, the major enzyme responsible for clot breakdown. Synthetic tPA is a medication that is used in hospitals to break up clots in heart attack and ischemic stroke patients.)
- This benefit may be short-lived, however, diminished fibrinolytic activity is seen for several minutes up to 18 hours after discontinuation of pneumatic compression.
Mechanical compression should be initiated prior to induction of anesthesia for surgical/obstetrical patients and continue into the post anesthesia care unit.
Mechanical compression devices should be removed for only a short time each day (no more than 30 minutes) for patient bathing, ambulation/exercise or for nursing personnel to perform skin assessments.
According to Dr Franklin Michota, “Physician Orders for the use of mechanical compression devices should include instructions in the patient’s medical record specifying how- and for how many hours per day- they are to be worn. Not doing so leaves the physician vulnerable to litigation” should the patient develop a DVT or PE.
What might this mean for clinical practice?
- Recognize the importance of compliance with mechanical compression as well as continued need throughout the entire hospitalization
- This could form the basis for clinical recommendation instructions to patients on the time mechanical compression should be worn each day.
- Supports the need for time to removed, in terms of, conducting proper skin inspection.