Myth: Patients don't need to be measured for mechanical prophylaxis
CONTRIBUTOR
Wynne Parry
Essential Insights contributor, healthcare writer
Editor’s note: This article was updated on April 7, 2021.
Myth: Patients don't need to be measured for mechanical prophylaxis.
Truth: Intermittent pneumatic compression (IPC) device sleeves, foot pump covers, and stockings come in multiple sizes.
It's important to find the right size, because a poor fit puts the patient at risk of not receiving the full benefit of the intervention.
Used correctly, mechanical prophylaxis helps prevent VTE
IPC devices should be worn at least
18 out of 24 hours
Numerous clinical trials show that the use of mechanical interventions, and IPC in particular, can reduce risk of venous thromboembolism (VTE). Examples include:
- A prospective, randomized study of gynecological surgery patients tested combinations of stockings, compression devices, and pharmacological prophylaxis. For very high risk patients, the use of all three together produced the lowest incidence of deep-vein thrombosis (DVT), the researchers write in Scientific Reports.
- A randomized clinical trial compared outcomes for 1438 immobile stroke patients who received IPC with 1438 who did not. The researchers report in The Lancet that IPC effectively reduces the risk of blood clots, and possibly improves survival.
To be effective, however, these interventions must remain on patients most of the time. Guidelines issued by the Association for periOperative Nurses (AORN) and the American College of Chest Physicians recommend patients wear the IPC devices 18 hours or more per day.
Find the best fit
Patients' feet and legs come in all sizes. So do these interventions.
Measuring for size is necessary. A slim woman might have a thigh circumference size of 16 inches, for example, while a large man might measure 26 inches.
IPC device sleeves:
To determine the best size for sleeves, measure the circumference of the patient's calf and, for some longer sleeves, his or her thigh. AORN advises in its guidelines to:
- Assess the patient for contraindications to IPC use.
- Follow the manufacturer's instructions.
- Place the tubing so as to prevent pressure injuries.
- Verify that the sleeves have been put on correctly, that they connect to the pump, and that the device is on.
Foot pumps:
Depending on the type of foot cover used, you may need your patient's shoe size.
Compression stockings:
For thigh length stockings, measure the circumference and length of the thigh and calf. Shorter stockings require only the calf circumference and length. AORN recommends measuring the legs separately, since they may need different sizes. Its guidance also notes that incorrect sizing of stockings may cause injury or reduce the effectiveness of VTE prevention.
Comfort matters
If you order mechanical compression therapy for a patient, using the right size helps ensure that your patient is comfortable and receives the full benefit of the therapy. In the first half of a multicenter prospective study, providers stopped using a thigh-length IPC sleeve because it did not remain in place. After the sleeve was redesigned for a better fit, 82 percent of patients preferred the new option. Writing in Orthopaedic Nursing, the researchers speculate that the more comfortable IPC sleeve would improve compliance and optimize patient outcomes.
Regardless of the type of mechanical compression therapy used, taking a smart approach means ensuring the intervention fits the patient.
