Blood Clots, Practices & Tips

Clinical Tip: How long should mechanical compression devices be worn each day to have the best patient outcome?

Mechanical compression devices should be worn at least 18-20 hours a day to be effective.

By Lynn Razzano RN, MSN, ONCC

Graduated compression stockings and other mechanical compression devices have been shown not to be effective unless they are worn at least 18- 20 hours a day.

Mechanical compression devices exert their therapeutic effects by limiting venous stasis and enhancing fibrinolysis.

  • Research has shown patients who received intermittent pneumatic calf compression preserved the normal thrombin/plasmin ratio in blood samples obtained vs. those not receiving pneumatic compression. This demonstrates that intermittent pneumatic calf compression helps prevent  hypercoaguable states that contribute to development of VTE.
  • Mechanical compression devices increase venous blood flow velocity and have been shown to increase the amount Tissue Plasminogen Activator -tPA.    (Tissue plasminogen activator is a protein involved in the breakdown of blood clots.  It is found on endothelial cells, the cells that line the blood vessels.   As an enzyme, it catalyzes the conversion of plasminogen to plasmin, the major enzyme responsible for clot breakdown.   Synthetic tPA is a medication that is used in hospitals to break up clots in heart attack and ischemic stroke patients.)
  • This benefit may be short-lived, however, diminished fibrinolytic activity is seen for several minutes up to 18 hours after discontinuation of pneumatic compression.

Mechanical compression should be initiated prior to induction of anesthesia for surgical/obstetrical patients and continue into the post anesthesia care unit.

Mechanical compression devices should be removed for only a short time each day (no more than 30 minutes) for patient bathing, ambulation/exercise or for nursing personnel to perform skin assessments.

According to Dr Franklin Michota, “Physician Orders for the use of mechanical compression devices should include instructions in the patient’s medical record specifying how- and for how many hours per day- they are to be worn.  Not doing so leaves the physician vulnerable to litigation” should the patient develop a DVT or PE.

What might this mean for clinical practice?

  • Recognize the importance of compliance with mechanical compression as well as continued need throughout the entire hospitalization
  • This could form the basis for clinical recommendation instructions to patients on the time mechanical compression should be worn each day.
  • Supports the need for time to removed, in terms of, conducting proper skin inspection.

9 thoughts on “Clinical Tip: How long should mechanical compression devices be worn each day to have the best patient outcome?

  1. Katherine Neville

    You state “Mechanical compression should be initiated prior to induction of anesthesia for surgical/ obstetrical patients … where is the research to support mechanical compression initiated PRIOR to induction.
    Thank you

    • Michael Wong

      Mira, in her article “Enhancing patient outcomes with sequential compression device therapy”, Cathy Moore MSN, RN, ACNS-BC, CCRN writes that SCD therapy “should begin on admission and continue as long as the patient has limited mobility” –

      • Brian Gallagher

        Thanks a million, Michael! Your sources for research and proper use of SCDs are very informative. Thanks again for your sharing this info.

    • Beryl O'Connor

      If Sequential calf compression device has been off for 4 hours should they be recommenced if the patient becomes bed ridden (BMI 44)?
      What is the maximum time the can be off before recommencing?

  2. eric

    Can a compression device be used for edema in the legs. I have cirrhosis of the liver and have had acute renal failure recently, Kidney, ( July 2018). My stomach distension seems to be moving down to my legs.

    • Michael Wong

      Great question. In research on the effectiveness of pneumatic compression in long-term therapy of lymphedema of lower limbs on conducted at the Medical Research Center, Polish Academy of Sciences, and Department of Surgery, Central Clinical Hospital, Ministry of Internal Affairs, Warsaw, Poland, the researchers concluded, “IPC takes over the permanently missing function of the obliterated lymphatics by squeezing edema tissue fluid to the regions with normal lymphatic drainage. The limb circumference is decreased or at least does not further increase, elasticity of tissue is increased and maintained. No complications in limb tissues were observed. The long-term, high pressure IPC, long inflation timed therapy can be safely be recommended to patients with lower limb lymphedema.” –

  3. Ives wong

    Can we apply the sequential compression device on top of pressure garment or pressure stockinette?
    If can do so, is it a harm to induce necrosis or compartment syndrome?
    Too high pressure??

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