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.

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

  1. 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

    1. 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” –

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

    2. 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. 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.

    1. 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. 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??

  4. I can’t find an answer to this anywhere: I had a total hip arthroplasty 12 days ago and have been walking 2.5 miles daily for 6 days. My postop visit isn’t for another 4 days and I am dying to ditch these things. What are the idds my surgeon will let me? He originally said 20 hrs a day for 30 days.

    1. Please follow your doctor’s recommendations for 20 hours per day for 30 days.

      Best practice evidenced-based standard (American Academy of Orthopaedic Surgeons as well as National Association of Orthopaedic Nurses), THR arthroplasty is in the highest risk category for VTE and typically fatal arising from the femoral vein where 70% of the lethal clots form.

      Although you are only 12 days post-op and although you should be applauded for your progressive mobility status, your surgeon stated 30 days. During sleep which is typically 8 hours, you need a mechanical SCD to keep your blood moving – stasis or inactivity causes blood clots to form.

      Best practice at New England Baptist Hospital states 30 days for SCD compression/elastic stocking.

      If you’ve been prescribed an anticoagulant, please continue taking these as well as any DVT prevention prescribed by your clinicians.

  5. Three years ago I had surgery for a torn tendon in my right foot and subsequently three weeks postop developed a PE and survived. Since then I have been on blood thinners due to an undiagnosed blood clot disorder. Two weeks ago I had foot/ankle surgery to repair a torn tendon, remove fibromas, and shave down the navicular bone in my foot. Since surgery I have been wearing calf pumps and both my right and left legs but my doctor is in uncharted territory as he’s never had a patient throw a double PE and he is unsure as to how long I should wear the calf pumps. Currently I wear them A few times a day for at least an hour at a time. Do I wear them until I am mobile? As of right now I am not no weight bearing.

    1. As Lynn Razzano wrote in her article, “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.” Please continue to wear compression devices as prescribed by your doctor.

    1. Thanks, Diane, for a very good question. According to Saint Luke’s Health System, “After surgery, ankle pumps will help prevent circulation problems, such as blood clots.” To read their article and exercises to help speed recovery, please click here.

  6. I had a spinal surgery , how long do i have to use it the plasma flow , i was in bed for 2 weeks but after that i start to walking i can do more things right now so

  7. Should you wear plasma flow compressions to bed? And if so how do you wear them when you should have the brace on as well

    1. As Lynn Razzano recommends in this article, “Mechanical compression devices should be worn at least 18-20 hours a day to be effective.”

  8. I had rotator cuff and bicep repair 12 days ago. I was told to wear the calf compression devices when I sleep but, no one stated how long I needed to wear them. I am very active and have had no problems so far. My next follow up is 4 weeks away. How long do I need to continue to wear them?

    1. Please ask your doctor how long you should wear the compression device. As this Cleveland Clinic article provides, “Ask your healthcare provider how long you should use the device. Typically, once you get up and move regularly like you were before, the risk of DVT decreases, and you can stop wearing the IPC device.”

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