Applying Pneumatic Compression Devices

Skill 9-11

Applying Pneumatic Compression Devices

Pneumatic compression devices (PCDs), also known as intermittent pneumatic compression devices (IPCDs) and sequential compression devices (SCDs), consist of fabric sleeves containing air bladders that apply brief pressure to the legs. Intermittent compression pushes blood from the smaller blood vessels into the deeper vessels and into the femoral veins. This action enhances blood flow and venous return, stimulating the normal muscle-pumping action in the legs, and promotes fibrinolysis, deterring venous thrombosis (DVT). The sleeves are attached by tubing to an air pump. The sleeve may cover the entire leg or may extend from the foot to the knee.

PCDs may be used in combination with graduated compression stockings (antiembolism stockings) and anticoagulant therapy to prevent thrombosis formation. They can be used preoperatively and postoperatively with patients at risk for blood clot formation. They are also prescribed for patients with other risk factors for clot formation, including inactivity or immobilization, chronic venous disease, and malignancies. Use of a pneumatic compression device is a prescribed intervention and may be prescribed for high-risk surgical patients, those with decreased mobility or chronic venous disease, and patients at risk for deep vein disorders. PCDs/SCDs should be kept on at all times except when patients are walking (Wilson et al., 2018).

Delegation Considerations

The application and removal of PCDs may be delegated to assistive personnel (AP) as well as to licensed practical/vocational nurses (LPN/LVNs). The decision to delegate must be based on careful analysis of the patient's needs and circumstances as well as the qualifications of the person to whom the task is being delegated. Refer to the Delegation Guidelines in Appendix A.

Equipment

Compression sleeves of appropriate size based on the manufacturer's guidelines
Inflation pump with connection tubing
PPE, as indicated

Assessment

Assess the patient's history, health record, and current condition and status to identify risk for development of deep vein thrombosis. Assess lower extremity skin integrity. Identify any leg conditions that would be exacerbated by the use of the pneumatic compression device or would contraindicate its use.

Actual or Potential Health Problems and Needs

Many actual or potential health problems or issues may require the use of this skill as part of related interventions. An appropriate health problem or issue may include:

Venous thromboembolism risk
Altered skin integrity risk
Risk for impaired peripheral neurovascular function

Outcome Identification and Planning

The expected outcomes to achieve when applying a PCD are that the patient maintains adequate circulation in the extremities, and the patient understands the rationale for stocking application and is free from symptoms of neurovascular compromise and DVT.

Implementation

Action	Rationale
1. Review the health record and prescribed interventions to determine the need for a pneumatic compression device (PCD) and for conditions that may contraindicate its use.	Reviewing the health record and prescribed interventions validates the correct patient and correct procedure and minimizes the risk for injury.
2. Perform hand hygiene. Put on PPE, as indicated.	Hand hygiene and PPE prevent the spread of microorganisms. PPE is required based on transmission precautions.
3. Identify the patient. Explain the procedure to the patient.	Patient identification validates the correct patient and correct procedure. Discussion and explanation help allay anxiety and prepare the patient for what to expect.
4. Close the curtains around the bed and close the door to the room, if possible. Place the bed at an appropriate and comfortable working height (VHACEOSH, 2016).	Closing the door or curtains provides for privacy. Proper bed height helps reduce back strain.
5. Hang the compression pump on the foot of the bed and plug it into an electrical outlet (Figure 1). Attach the connecting tubing to the pump.	Equipment preparation promotes efficient time management and provides an organized approach to the task.
6. Remove the compression sleeves from the package and unfold them. Lay the unfolded sleeves on the bed with the cotton lining facing up. Note the markings indicating the correct placement for the ankle and popliteal areas.	Proper placement of the sleeves prevents injury.
7. Apply graduated compression stockings. Place a sleeve under the patient's leg with the tubing toward the heel. Each one fits either leg. For total leg sleeves, place the behind-the-knee opening at the popliteal space to prevent pressure there. For knee-high sleeves, make sure the back of the ankle is over the ankle marking.	Proper placement prevents injury.
8. Wrap the sleeve snugly around the patient's leg so that two fingers fit between the leg and the sleeve. Secure the sleeve with the Velcro fasteners. Repeat for the second leg (Figure 2), if bilateral therapy is prescribed. Connect each sleeve to the tubing, following manufacturer's recommendations (Figure 3).	Correct placement ensures appropriate, but not excessive, compression of the extremity.
9. Set the pump to the prescribed maximal pressure (usually 35 to 55 mm Hg). Make sure the tubing is free from kinks. Check that the patient can move about without interrupting the airflow. Turn on the pump. Initiate cooling setting, if available.	Proper pressure setting ensures patient safety and prevents injury. Some devices have a cooling setting available to increase patient comfort.
10. Observe the patient and the device during the first cycle. Check the audible alarms.	Observation and frequent checking ensure proper fit and inflation and reduce the risk for injury from the device.
11. Place the bed in the lowest position. Make sure the call bell and other essential items are within easy reach.	Returning the bed to the lowest position and having the call bell and other essential items readily available promote patient safety.
12. Remove PPE, if used. Perform hand hygiene.	Proper removal of PPE reduces the risk for infection transmission and contamination of other items. Hand hygiene prevents the spread of microorganisms.
13. Assess the extremities for peripheral pulses, edema, changes in sensation, and movement. Check the sleeves and pump at least once per shift or per facility policy. Remove the sleeves and assess and document skin integrity every 8 hours.	Assessment provides for early detection and prompt intervention for possible complications, including skin irritation.

Evaluation

The expected outcomes have met when the patient has exhibited adequate circulation in extremities without symptoms of neurovascular compromise and DVT, and the patient has verbalized an understanding of the rationale for stocking application.

Documentation

Guidelines

Document the time and date of application of the PCD, the patient's response to the therapy, and the patient's understanding of the therapy. Document the status of the alarms and pressure settings. Note the use of the cooling setting, if appropriate. Document your assessment of the extremities.

Sample Documentation

Developing Clinical Reasoning and Clinical Judgment

Unexpected Situations and Associated Interventions

Your postoperative patient is wearing PCD on both legs. While you are performing a routine assessment, he tells you that he has started to have pain in his left leg, along with tingling and numbness: Remove the PCD and assess both lower extremities. Perform skin and neurovascular assessments. Assess the extremities for peripheral pulses, edema, changes in sensation, and movement. Communicate the patient's symptoms and assessment to the health care team.

Special Considerations

Use the cooling setting, if the unit has one. The skin under the sleeve can become wet with diaphoresis, which can increase the risk for impaired skin integrity.
In general, the PCD should be worn continuously. It may be removed for bathing, walking, and physical therapy. Use is usually discontinued when the patient is ambulating consistently.
The risk for DVT formation and injury as a result of excessive pressure on blood vessels and underlying tissues is greater if the sleeves are not applied correctly (Rabe et al., 2020).

EVIDENCE FOR PRACTICE
Venous Thromboembolism Prevention American Association of Critical-Care Nurses (AACN). (2016). Practice alert. Preventing venous thromboembolism in adults. https://www.aacn.org/clinical-resources/practice-alerts/venous-thromboembolism-prevention Refer to details in Skill 9-10, Evidence for Practice.

EVIDENCE FOR PRACTICE
Pneumatic Compression and Prevention of Thrombosis National Institute for Health and Care Excellence (NICE) (UK). (2019). Venous thromboembolism in over 16s: Reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. NICE Guideline. https://www.nice.org.uk/guidance/ng89 Refer to the details in Skill 9-6, Evidence for Practice.

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Skill 9-11

EVIDENCE FOR PRACTICE

EVIDENCE FOR PRACTICE