Evidence-based guidelines: 5 ways to improve VTE prevention with mechanical prophylaxis

An investigation in BMC Urology determined that reasons for noncompliance include lack of devices, delays in replacing them, and patients' own objections.

Kyle recommends that clinicians prepare to discuss the need for mechanical prophylaxis at every phase of care. “Patients typically ask questions around why they have to wear these things around their legs," she said.

Five ways to improve prevention

The updated guidelines highlight opportunities to make mechanical prophylaxis more effective, patient friendly, and safer for everyone, including clinicians in the operating room.

Here are five key takeaways:

1. Track how long patients wear their devices

If patients haven't fully bought into their plan of care, they may not have the motivation to keep the devices on their legs for 18 plus hours a day, according to Kyle. She noted that patients can remove some older machines and easily circumvent their alarms, so documenting run time alone isn't adequate.

“A device that records wear time is ideal because it gives the health care team objective information about whether or not the patient received prophylaxis," she said.

2. Go cordless

Not only are battery-operated compression devices safe and effective, evidence suggests they may increase patient compliance. An investigation in the American Journal of Surgery found a 47% compliance rate among patients given devices requiring an outlet versus 85% among those given devices with batteries.

The study's authors cite two primary reasons: Battery-operated devices don't need to be unplugged then plugged back in when a patient is transferred or during ambulation, another crucial component of VTE prevention.

“If the device is portable, they can get out of bed with it, without a lot of difficulty," Kyle said. “Ease of use for patients equals better patient compliance."

There's another bonus: Losing the electrical cord means eliminating a tripping hazard. “The fewer cords on the floor of the operating room, the better," Kyle said.

3. Engage patients in mechanical VTE prevention measure selection

If patients object to wearing thigh-length stockings, nurses may substitute knee-length ones that are less restrictive. Studies have yet to clearly show that thigh-length compression stockings are more effective than knee-length ones. Given this uncertainty, and that stockings are only effective if worn, the guidelines recommend taking patient preference into account.

4. Avoid elastic bandages

Elastic bandages may not provide adequate protection against VTE and can create a risk of skin, pressure, and nerve injuries and can create a tourniquet effect.

5. Start the conversation early

Kyle emphasizes communication with patients. "In that initial visit, before the patient comes in for surgery, it may be a good idea to introduce them to some of the devices they will be asked to wear postoperatively, so they know what to expect," she said. “Patients should be full partners in care planning and they should be educated about risk."