Why aren't we talking about IPC devices more often to reduce blood clot risk?

Here are a few elements worth considering:

• Total blood volume moved: Conventional compression cycles move blood at a lower volume per hour than a device that adjusts for various refill times. Why? If you're not timing a patient's unique vascular refill cycles, you're not moving as much blood as you can. When customizing compression with vascular refill detection, a patient could achieve optimal frequency of compression cycles every hour according to their individual needs. This translates to achieving a higher volume of blood moved compared to that of an IPC system with a preset default compression cycle setting.
  
  
• Sustained blood flow: A study comparing the hemodynamic effects of sequential, gradient sleeves versus uniform sleeves found that sequential, gradient sleeves achieve "a higher average velocity." While the study found that single-chambered sleeves "produced a significant rise in venous blood flow velocity," this increase "could not be maintained."
  
  
• Unidirectional blood flow: According to one study using a compression model, "numerical results indicate that the effectiveness of uniform compression is severely compromised by the formation of a flow-limiting throat at the proximal end of the compression cuff that reduces both the rate at which blood is discharged from the lower leg and the total blood volume removed. Both of these detrimental effects can be avoided by the use of either wavelike [or] graded compression." Graded or wavelike compression provides a greater, more uniform velocity and shear augmentation than uniform compression.
  
  
• Differences in venous refill time (VRD): When unique patient factors are not considered, the patient may receive a second cycle of compression long after the veins have refilled with blood. Timing a patient's unique vascular refill cycle through VRD can support blood flow, resulting in more compression cycles over time. Functional differences between types of IPC devices could result in different outcomes — for example, differences in blood flow between devices with a fixed interval setting versus devices with a customized setting known as Vascular Refill Detection (VRD).

Portability

Recording and reporting

Wear-time tracking

Ability to adjust with patient's needs

Chest guidelines recommend IPC devices that are:

• Portable
  
  
• Capable of recording and reporting proper wear time on a daily basis for inpatients and outpatients. The Chest guidelines recommend that "efforts should be made to achieve 18 hours of compliance."

In this light, consider whether:

• Meters track actual wear time of the sleeve and not just the run time of the pump as conventional devices do.
  
  
• The pump adjusts as the patient's needs change.

* Internal survey available upon request.