Mobility Minute: It’s Time To Say ‘No To Pneumatic’
Welcome the mobility minute; a space for evidence-based bias. Let’s talk IPCDs:
The bulky pumps… the cumbersome tubes… reports of patient discomfort… an all too familiar scene for clinicians relying on intermittent pneumatic compression devices (IPCD) to provide mechanical prophylaxis and mitigate patient risk for blood clots. The laundry list goes on when it comes to patient non-compliance and reports of clinician dissatisfaction with these devices. IPCDs are the standard script for patients in need of a squeeze of a limb (often the leg) to prevent blood clots, the leading cause of hospital death in the United States.¹ You read that right. Blood clots kill more people on a yearly basis than AIDS, breast cancer, prostate cancer and motor vehicle crashes combined!²
Blood clots often occur in the deep vein of the leg. This type of clotting is a direct result of several risk factors including immobility. As you can imagine, hospital patients are some of the most immobile groups of people you’ll find. Whether a patient is coming out of surgery or dealing with a myriad of other complications that would put someone under acute care, one thing is true: The ultimate prescription for recovery is mobility.
If mobility is medicine, IPCDs are the ailment. Tubes and cords tether a patient to their bed and substantially increase fall risk potential,³ which in turn reduces mobility and ultimately increases length of stay. Patient compliance is extremely low with IPCDs. The sleeves are frequently not worn and/or the pumps are not turned on. A study at two university-affiliated level one trauma centers found IPCDs to be functioning properly on only 19% of trauma patients.⁴ In another study of gynecologic oncology patients, 52% of IPCs were functioning improperly and 25% of patients experienced some discomfort, inconvenience, or problems with external pneumatic compression.⁵ In addition the most significant barrier to noncompliance is the patient’s discomfort with sleep interference.⁶
Another, often overlooked, aspect of IPCDs is the pneumatic or air-moving mechanism that inflates the sleeve chambers to cause a compression. With air quality becoming a front-of-mind concern, hospitals are paying more and more attention to air movement and possible contamination risk for patients. Some nationwide systems have even released patient safety notices around the use of IPCDs in certain populations.
If you know, you know. IPCDs are in desperate need of a better solution for both the patient and clinician. With such devastating consequences on the table for those at risk for blood clots, it’s time to rethink mechanical prophylaxis for compression in the hospital. It’s time to rethink pneumatics!
+ References
(1) - Jha AK, Larizgoitia I, Audera-Lopez C, Prasopa-Plaisier N, Waters H, Bates DW. The global burden of unsafe medical care: analytic modeling of observational studies. BMJ Qual Saf 2013; 22;809-15. Retrieved from: http://qualitysafety.bmj.com/content/22/10/809.full.pdf+html
(2) - Cohen AT, Agnelli G, Anderson FA, et al. Venous thromboembolism (VTE) in Europe. Thromb Haemost. 2007;98:756-764
(3) - Unexpected risk from a beneficial device: sequential compression devices and patient falls. PA-PSRS Patient Saf Advis. 2005 Sep;2(3):13-5.
(4) - Cornwell EE, 3rd, Chang D, Velmahos G, et al. Compliance with sequential compression device prophylaxis in at-risk trauma patients: a prospective analysis. Am Surg. 2002;68(5):470-473. PubMed
(5) - Jürgen L Holleck, MD, Craig G Gunderson, MD, Things We Do for No Reason: Intermittent Pneumatic Compression for Medical Ward Patients?. J. Hosp. Med 2019;1;47-50. doi:10.12788/jhm.3114
(6) - Kim S. Pamela, MD, The Staff and Patient Perspectives on Compliance with Mechanical Prophylaxis for Veneous Thromboembolism. Journal of Vascular Surgery 2018; Vol. 6 No. 4: 445
