The durat ion of compression is 11 seconds with a 60 second relaxation period between compressions. The sequential pattern of compression has been well described: chambers of the extremity garment are sequentially inflated from ankle to knee (or mid thigh) to a maximum pressure of 45-50mm Hg at the ankle, 35 mm Hg at the calf, and 30mm at the thigh (hence the term “gradient” compression). Scientific and clinical evaluations of SCDs strongly suggest that the nature of their effect on DVT prophylaxis derives from their ability to increase mean and peak femoral vein velocity as well as their effect on the systemic coagulation and fibrinolytic mechanisms. Since their description in 1858 by Rudolf Virchow, the factors that are felt to form the basis of the pathophysiology of venous thromboembolic disease are stasis (reduction of blood flow in the veins), injury (to the intimal surface of the vessel) and hypercoagulability. For patients in whom the lower extremity is inaccessible to place SCDs at the calf level, foot pumps may act as an effective alternative to lower the rate of DVT formation.In the subset of spine-injured head-injured patients, SCD may have some benefit in isolated studies.There is insufficient data at this time that SCD decreases the risk of VTE in multiply injured patients. There are insufficient data to support a standard on this topic. Those articles pertinent to trauma-related thromboembolism prevention were reviewed.Twenty-three of these articles were evaluated to formulate the following guidelines. ProcessĪ Medline search from 1986 to the present produced a large number of articles on this topic. Complications of SCDs have been noted in case reports and have been associated with improper positioning of the lower extremity during surgery which should be avoided. TEDS), however, this practice has not been widely studied and is not standard. Unanswered questions regarding the use of SCDs include the mechanism by which SCDs act, the efficacy of SCDs worn on the upper extremities or a single lower extremity compared to both lower extremities, the nature of risk involved in discontinuing SCDs periodically during use, and the duration of SCD use.Reports suggest that SCDs should be worn with thromboembolism-deterrent stockings (i.e. In a number of prospective, randomized studies, SCDs have been shown to reduce the incidence of both DVT and PE. Additionally, SCDs have been shown to have a direct effect on the fibrinolytic pathway acting to shorten the euglobulin lysis time, increase levels of coagulation cascade inhibitor molecules, as well as affecting the balance of plasminogen activation. Īttacking the long-recognized risk factor of stasis, SCDs have been shown to increase mean and peak femoral venous blood velocities on the lower extremity. The role of intermittent sequential compression devices (SCDs) for prophylaxis against DVT has been studied and increasingly utilized in general surgery patients, orthopedic patients, and trauma patients. University of Vermont Department of Surgeryĭepartment of Surgery, Division of Trauma and Critical Care Exempt Purpose, Mission, Vision & GoalsĪuthors EAST Practice Parameter Workgroup for DVT Prophylaxis.Interviews with Research Scholarship & Award Recipients.Equity, Diversity, and Inclusion in Trauma Surgery Practice.Landmark Papers in Trauma and Acute Care Surgery.
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