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Sequential Compression Device For Legs and/or Feet (Adult) (1.29A)

Sequential Compression Device For Legs and/or Feet (Adult) (1.29A) - Policies, Clinical, UWHC Clinical, Department Specific, Nursing Patient Care, Cardiovascular and Infusion

1.29A

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NURSING PATIENT CARE POLICY & PROCEDURE





Effective Date:
September 22, 2017


Administrative Manual
Nursing Manual (Red)
Other _______________

Policy #: 1.29A

Original
Revision

Page
1
of 4

Title: Sequential Compression Device for
Legs and/or Feet (Adult)-Inpatient/HOD

I. PURPOSE

To apply external pneumatic compression to the venous system of the legs and/or feet
to aid in increasing blood flow clearance and reducing stasis and to prevent deep vein
thrombosis (DVT).

II. POLICY

When indicated, surgical patients should have the sequential compression device
(SCD) applied as soon after surgery as possible. Ensure that the patient has an order
for mechanical venous thromboembolic (VTE) prevention.

III. EQUIPMENT

A. Controller compression device (order in the electronic health record).
B. Vinyl sleeves (pair), available from Central Services (CS) in knee length sizes:

Vinyl Sleeves Size
Small/Medium Fits calf size up to 21 inches (circumferential)
Large Fits calf size of 19-21 inches (circumferential)
Extra Large Fits calf size of 22-32 inches (circumferential)

C. Foot Cuffs:

Regular Express Foot Cuff® Large Express Foot Cuff®
Women's shoe size Less than or equal to size 7.5 Size 8 or greater
Men's shoe size Less than or equal to size 9 Size 9 or greater

NOTE: Do not use controller in presence of flammable anesthetics.

IV. PROCEDURE

A. Obtain provider's order for treatment schedule, and extremity(ies) to be treated.
1. Consider contraindication for sleeves/cuffs for patients with the following:
a. Any local condition with which sleeves would interfere, such as:
dermatitis, vein ligations (immediate post-operative), gangrene or
recent skin graft.

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b. Severe arteriosclerosis or other ischemic vascular disease.
c. Massive edema of legs or pulmonary edema from congestive heart
failure.
d. Extreme deformity of leg/foot.
e. Suspected pre-existing deep venous thrombosis.
f. Patient has an open wound or severe cellulitis.
B. Position controller to allow clear space at both sides for air intake and venting.
C. Plug power cord into a grounded receptacle.
D. Check that power switch on controller is off.
E. For leg sleeves:
1. Hold the sleeve against the leg, wrap the sleeve securely (not tightly)
around the leg, and attach Velcro fastener strip firmly. Two fingers should
fit comfortably between the patient's leg and the sleeve prior to inflation.
F. For foot cuffs:
1. Place the bottom of the foot directly in the center of the cuff, wrapping the
flap over the top, and positioning the support strap around the back of the
heel with a snug “sneaker fit” prior to inflation.
G. Plug one end of the tubing set(s) into the back of the controller. Plug the sleeve or
cuff end of the tubing set(s) into the sleeves or cuffs wrapped on the patient's
limbs. Ensure the tubing is not kinked. Match the left and right controller ports to
the left and right limbs of the patient.
H. The controller can operate with one or both sleeves and/or cuffs attached to the
patient. If using the device on one extremity, connect just one tube to the
controller and sleeve/cuff. Do not connect the second tubing if not attaching both
sleeves to the patient or an alarm will result.
I. Turn on the power switch on the controller. On the front display, the Port A Leg
and Port B Leg indicators will be flashing to indicate normal operation. If only
one sleeve and corresponding port is being used, the controller will automatically
sense this and turn off the unused port. The device automatically defaults to the
legs. When using the device on the patient’s foot/feet, press the “A” and/or “B”
buttons located on the control panel to confirm that the foot cuffs have been
connected.
J. Once applied to the patient, the staff member applying the device should carefully
watch the patient’s leg(s) as the device completes one full cycle to assess for
proper function and adequate tightness so that the patient receives full therapeutic
benefits.
K. Battery operation
1. All controllers will operate on battery power if necessary but should
remain plugged in when in use. Battery operation time is 6-8 hours on a
fully charged battery.
L. Unless otherwise ordered, to achieve the maximal preventative therapy of the
device, the patient should be wearing them at all times while they are in bed with
only minimal interruptions or removal
M. In the case of a fault condition, the alarm will sound. The appropriate fault code
will be displayed and the system will shut down. Refer to the fault code key
located on top of the controller. Check tubing for kinks or restrictions, tighten or
loosen sleeves/cuffs as indicated on the code key and then re-start the system by
pushing the power switch to off, then back to on.

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N. Sleeves/cuffs should be removed if patient experiences numbness, tingling, leg
pain, or excessive constriction related to the use of the device.
O. As part of the nursing assessment, open the sleeves and assess skin condition.
P. Document use in the patient's clinical record.
Q. For infection control and safety purposes, the compression sleeves/cuffs and
tubings should be placed on top of the foot of the bed and should not be placed on
the floor when not in use. The non-patient contact side of the sleeves/cuffs may be
spot cleaned with hospital disinfectant if minimally soiled and not in proximity to
an open wound. Replace sleeves/cuffs if soiled.
R. Discontinue treatment regime as ordered. Unplug sleeve/cuff tubing and return
sleeves to soiled utility room (ACCO) for reprocessing. Sleeves/cuffs soiled with
blood or feces should be disposed of in accordance with standard precautions.
Tubing is not disposable and must be returned to CS.
S. At The American Center (TAC) the Controller Compression Device should
remain in the room to be cleaned by Environmental Services Staff (EVS) at
discharge according to hospital equipment cleaning standards.

V. REFERENCES

A. UW Health Practice Guidelines, Venous Thromboembolism Prophylaxis – Adult
– Inpatient/Ambulatory Clinical Practice Guideline, December 2016.
B. Ashworth, S. (2014). Sequential compression devices and clots. Critical Care
Nurse, 34(6), 68-69.
C. Autar, R. (2010). A review of venous thromboprophylaxis in patients undergoing
hip fracture surgery (HFS). International Journal of Orthopaedic and Trauma
Nursing, 14(2), 88-95.
D. Autar, R. (2011). Evidence based venous thromboprophylaxis in patients
undergoing total hip replacement, total knee replacement and hip fracture surgery.
International Journal of Orthopaedic and Trauma Nursing, 15(3), 145-154.
E. Collins, R., MacLellan, L., Gibbs, H., MacLellan, D., & Fletcher, J. (2010).
Venous thromboembolism prophylaxis: the role of the nurse in changing practice
and saving lives. Australian Journal of Advanced Nursing, 27(3), 83-89.
F. Fenner, L. B., & Oliver, C. (2012). Prevention of deep vein thrombosis and
pulmonary embolus. Anesthesia and Intensive Care Medicine, 13(12), 609-612.
G. Ibrahim, M., Ahmed, A., Mohamed, W., & Abduo, S. (2015). Effect of
compression devices on preventing deep vein thrombosis among adult trauma
patients. Dimensions of Critical Care Nursing, 34, (5), 289-300.
H. Kendall A-V IMPULSE SYSTEM OPERATOR'S INSTRUCTION MANUALS
FOR MODEL 6060.
I. Larkin, B. G., & Petrie, K. (2012). Translating evidence to practice for
mechanical venous thromboembolism prophylaxis. Association of PeriOperative
Nurses, 96(5), 513-527.
J. Obi, A., Alvarez, R., Reames, B., Moote, M., Thompson, M., Wakefield, T., &
Henke, P. (2015). A prospective evaluation of standard versus battery-powered
sequential compression devices in postsurgical patients. The American Journal of
Surgery, 209,(4), 675-681.
K. Sagi, H., Ahn, J., Ciesla, D., Collinge, C., Molina, C., Obremskey, W., &
Guillamondegui, O. (2015). Venous thromboembolism prophylaxis in orthopaedic

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trauma patients: A survey OTA member practice patterns and OTA expert panel
recommendations. J Orthop Trauma, 29,(10), 355-362.
L. SCD Express Compression System® Operation and Service Manual.
M. Solomon, E. R., Frick, A. C., Pariso, M. F. R., & Barber, M. D. (2010). Risk of
deep venous thrombosis and pulmonary embolism inurogynecological surgical
patients. American Journal of Obsteterics & Gynecology, 203, 510e, 1-4.

VI. REVIEWED BY

Clinical Nurse Specialist, Orthopedics and General Surgery
Clinical Nurse Specialist, Surgical Specialties and Inpatient Psychiatry
Nurse Manager, Orthopedics
Nursing Patient Care Policy and Procedure Committee, September 2017

SIGNED BY

Beth Houlahan, DNP, RN, CENP
Senior Vice President, Chief Nurse Executive