Safe Patient Handling
Using a Sequential Compression Device
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- » Using a Sequential Compression Device
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Take the Review Test:
Safety
- Verify the health care provider’s order for the type and frequency of application for sequential compression devices.
- Discourage the patient from activities that promote venous stasis, such as leg crossing and wearing garters.
- Obtain and become familiar with the type of sequential compression device to be used.
- Remove the sequential compression device at least once per shift for long enough to inspect the skin for irritation or breakdown.
Equipment
(Roll cursor over items to see labels)
Medical measuring tape
Elastic support stockings
SCD Motor, disposable SCD sleeves and tubing assembly
PrintableDelegation
The skill of applying a sequential compression device can be delegated to nursing assistive personnel (NAP) after the nurse initially determines the size of the sleeve and assesses the patient’s lower extremities for signs and symptoms of deep vein thrombosis (DVT) or impaired circulation.
Be sure to inform the NAP of the following:
- Remove the SCD sleeves before allowing the patient to get out of bed.
- Report to the nurse immediately if one calf appears larger than the other, or if it is red but not hot. Also report any signs of allergic reactions (redness, itching, irritation).
Preparation
- Verify the health care provider’s order for the type and frequency of application for sequential compression devices.
- Assess the patient for risk factors in Virchow’s triad:
- Hypercoagulability, such as that related to clotting disorders, fever, or dehydration
- Venous wall abnormalities such as those related to orthopedic surgery, varicose veins, or atherosclerosis
- Blood stasis, such as that related to immobility, obesity, or pregnancy
- Observe for contraindications for the use of sequential compression devices, including the following:
- Dermatitis or open skin lesions
- Recent skin graft to the lower legs
- Decreased arterial circulation in the patient’s lower extremities as evidenced by cyanotic, cool extremities and/or gangrenous conditions affecting the lower limb(s)
- Assess the condition of the patient’s skin and circulation to the legs by checking skin temperature and checking for the presence of pedal pulses, edema, discoloration of the skin, or lesions.
- Use a tape measure to measure the patient’s legs to determine the proper size of the sequential compression device.
- Know the patient’s home care plan. The patient may need to continue using the sequential compression device at home.
Follow-up
- Remove the SCD sleeves from the patient’s legs at least once per shift or for as long as it takes to inspect the skin for irritation or breakdown.
Documentation
- Record the date and time of SCD sleeve application, the skin condition and circulatory status of the legs before application, and the length and size of the SCD sleeves.
- Document the time of SCD sleeve removal as well as the skin condition and circulatory status of the legs after removal.
- Record and immediately report signs of thrombophlebitis or impeded circulation to the charge nurse or physician.
- Document your instructions to the patient and family about SCD use.
Review Questions
1. Why might a sequential compression device (SCD) be applied to the legs of an immobile patient?
To stimulate circulation in the deep arterial vascular system
To help prevent deep vein thrombosis (DVT)- To aid peripheral circulation to reduce the risk of skin breakdown
- To assist in passive range-of-motion exercise of the patient's lower extremities
INCORRECT. Compression devices affect venous, not arterial, blood flow.
CORRECT. The prevention of DVT by promoting venous circulation is a stated SCD application.
INCORRECT. SCDs are not intended to minimize skin breakdown.
INCORRECT. SCDs have no role in passive range-of-motion exercise.
2. While preparing to apply an SCD for a postoperative patient, the nurse realizes that which assessment observation contraindicates the application of the device?
- Having a low-grade fever
- Taking a prescribed anticoagulant
- Having dermatitis on the legs
- Wearing elastic stockings
INCORRECT. Having a low-grade fever is not a contraindication to the use of an SCD. It may, however, be an indication of DVT.
INCORRECT. Since anticoagulant medications are used to control thrombus formation, the patient's prescribed drug does not contraindicate the use of an SCD.
CORRECT. The presence of dermatitis or skin ulcers on the leg, or having had a recent skin graft to the leg, contraindicates the application of an SCD, since use of the device is likely to further alter skin integrity.
INCORRECT. The use of elastic stockings does not contraindicate the application of a sequential compression device.
3. The nurse has applied an SCD to a postoperative patient. The most appropriate way for the nurse to confirm proper fit is to do what?
- Ask the patient if the device is causing any pain.
- Ensure that two fingers will fit between the patient's leg and the device.
- Follow the manufacturer's instructions for the application of the device.
- Ask another nurse to check the patient for proper application of the device.
INCORRECT. The patient's complaint of pain may indicate that the device is too tight but does not indicate whether it is too loose.
CORRECT. Ensuring that two fingers can be inserted between the patient's skin and the device is the standard method for determining proper fit.
INCORRECT. Although the manufacturer's instructions should be followed, such instructions do not pertain to determination of fit for a specific patient.
INCORRECT. Asking another nurse to check the fit is not necessary unless the nurse is unsure of his or her ability to determine proper fit.
4. The nurse is preparing to delegate the application of an SCD to nursing assistive personnel (NAP). Which statement by the NAP requires follow-up by the nurse?
- "I will check for a green light on the mechanical unit.”
- "I will remove the SCD before ambulating the patient."
- "I will tell you if I see any signs of itching, redness, or irritation on the patient's legs."
- "I will measure the patient's legs to determine what size SCD sleeve to use."
INCORRECT. It is appropriate for NAP to check for the green light on the mechanical unit, so this statement does not require the nurse to follow up.
INCORRECT. It is appropriate for NAP to remove the device before ambulating the patient, so this statement does not require the nurse to follow up.
INCORRECT. It is appropriate for NAP to report such observations immediately, so this statement does not require the nurse to follow up.
CORRECT. Measuring the patient's legs to determine the appropriate size SCD sleeve to apply is an intervention that cannot be delegated, so this statement does require the nurse to follow up.
5. When preparing to delegate the application of an SCD to NAP, the nurse must do what first?
- Ask the NAP to demonstrate the proper application of the SCD
- Assess the patient's lower extremities for signs and symptoms of impaired circulation
- Assess the patient's need for an SCD
- Explain that the device is not to be removed
INCORRECT. The NAP need not demonstrate application of the device unless the NAP's ability to do so correctly is in question.
CORRECT. Before delegating the application of an SCD, the nurse must assess the patient's lower extremities for impaired circulation.
INCORRECT. The patient's need for an SCD has already been established, as evidenced by the physician's order; determining the patient's need for the device is a medical responsibility.
INCORRECT. An SCD can be removed to assess for skin breakdown or irritation and to permit the patient to ambulate to the bathroom.
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