Sequential compression devices in postoperative urologic patients: an observational trial and survey study on the influence of patient and hospital factors on compliance.

BACKGROUND: Sequential compression devices (SCDs) are commonly used for thromboprophylaxis in postoperative patients but compliance is often poor. We investigated causes for noncompliance, examining both hospital and patient related factors. METHODS: 100 patients undergoing inpatient urologic surgery were enrolled. All patient had SCD sleeves placed preoperatively. Postoperative observations determined SCD compliance and reasons for non-compliance. Patient demographics, length of stay, inpatient unit type, and surgery type were recorded. At discharge, a patient survey gauged knowledge and attitudes regarding SCDs and bother with SCDs. Statistical analysis was performed to correlate SCD compliance with patient demographics; patient knowledge and attitudes regarding SCDs; and patient self-reported bother with SCDs. RESULTS: Observed overall compliance was 78.6%. The most commonly observed reasons for non-compliance were SCD machines not being initially available on the ward (71% of non-compliant observations on post-operative day 1) and SCD use not being restarted promptly after return to bed (50% of non-compliant observations for entire hospital stay). Mean self-reported bother scores related to SCDs were low, ranging from 1-3 out of 10 for all 12 categories of bother assessed. Patient demographics, knowledge, attitudes and bother with SCD devices were not significantly associated with non-compliance. CONCLUSIONS: Patient self-reported bother with SCD devices was low. Hospital factors, including SCD machine availability and timely restarting of devices by nursing staff when a patient returns to bed, played a greater role in SCD non-compliance than patient factors. Identifying and addressing hospital related causes for poor SCD compliance may improve postoperative urologic patient safety.

Fundas de compresión neumática intermitente / Intermitent pneumatic compression hosiery

La utilización de sistemas de compresión gradual, como terapéutica asociada para el control de las patologías tromboembólicas, está comúnmente extendida (medias compresivas graduales, vendaje con vendas de crêpe…), aunque incrementa las cargas de trabajo para el profesional de enfermería, y su indicación son limitadas en pacientes de alto riesgo. Se ha generalizado la necesidad de utilizar dispositivos mecánicos, ampliamente reconocida por un nivel de evidencia razonable, para el control de la enfermedad tromboembólica venosa en aquellos enfermos con alto riesgo de sangrado en los que no es posible, o bien cuando está limitado el uso de fármacos para controlar dicha complicación en el paciente encamado. La compresión neumática intermitente (CNI) está integrada en buena parte de recomendaciones y guías de práctica clínica de asociaciones científicas y entidades especializadas como la American College of Chest Physicians (ACCP), y National Institute for Health and Clinical Excellence (NICE), entre otras. Por ello, queremos mostrar la sencillez de manejo de un dispositivo altamente eficaz en la prevención enfermedad tromboembólica venosa (ETEV), y cómo puede reducir las cargas de trabajo del personal de enfermería, a la vez que nos garantiza cuidados de alta calidad(AU)

The use of gradual compression systems (gradual compression hosiery, bandages composed of crepe strips,…) as therapeutic measures associated with the control of thromboembolic pathologies is a rather extensive common practice although their use increases the work load generated for nursing professionals; while at the same time, they have some indications to bear in mind and limited efficiency for use on high risk patients. The need to utilize mechanical devices has become a generally accepted practice, widely recognized as having a reasonable effectiveness level, to control thromboembolic vascular diseases on those bedridden patients who have a high risk of bleeding on whom the use of drugs to control this complication is not possible, or is limited. Intermitent pneumatic compression is integrated in the majority of recommendations and clinical practice guides published by scientific associations and specialized agencies such as the American College of Chest Physicians (ACCP), National Institute for Health and Clinical Excellence (NICE), among others. Therefore, the authors want to demonstrate the easy handling of a highly effective device to help prevent venous thromboembolic disease, and how it is possible to reduce the workload for nursing personnel while at the same time guarantee high quality care(AU)