Cardinal Health

Preventing Venous Thromboembolism: A Healthcare Professional Guide to Intervention 19 VTE Prevention. Mechanical. A. What mechanical options are used to reduce the incidence of VTE? Graduated Compression Stockings (GCS). GCS are anti-embolism devices that improve venous circulation and prevent venous distension in leg veins by applying graduated compression. Intermittent Pneumatic Compression (IPC). IPC are air driven devices which deliver uniform or gradient compression to the leg to facilitate emptying of veins and reduce venous stasis. Foot Impulse Technology (FIT). FIT mimics the natural physiological process that occurs when walking. A rapidly inflating bladder is positioned under the plantar venous plexus located in the sole of the foot. Upon compression the plexus rapidly expels a turbulent bolus of blood into the deep veins of the legs. FIT has three indications for use; • reduce the risk of DVT • reduce chronic and acute edema in the lower limbs and • enhance peripheral arterial blood flow. Inferior Vena Cava Filters. Inferior vena cava filters are sometimes used to mechanically reduce the risk of PE in very high risk patients with recurrent VTE who are contraindicated for anti-coagulation. These are placed endovascularly in the inferior vena cava. B. Are there any contraindications for use of mechanical prophylaxis? • GCS and IPC should be avoided if there are localised skin conditions, such as gangrene, immediate post-operative vein ligation, recent skin grafts, or leg deformity. • GCS and IPC should be avoided if patient suffers severe arteriosclerosis or other ischemic vascular disease. FIT is safe and indicated to enhance peripheral arterial blood flow. • IPC and FIT should not be used if a patient has a known or suspected acute DVT or PE; for these patients GCS are appropriate. • No mechanical prophylaxis should be used in patients with massive oedema or pulmonary oedema caused by congestive heart failure. C. What is the reason for using combined modalities of prophylaxis? Combined modalities are more effective in reducing the incidence of VTE than single modalities 17 . Combined use of GCS with either IPC or FIT address all three factors in Virchow’s Triad. Using GCS as part of a patient’s prophylactic regimen allows continual baseline prophylaxis when compression devices are interrupted, anticoagulants are withheld or patients are discharged from a facility. Virchow’s Triad and Prophylaxis. Vessel Wall Damage: GCS Coagulation Changes: IPC, FIT & Anticoagulants Stasis: IPC, FIT & GCS Virchow’s Triad