Dynamic Interface Pressure Monitoring System for the Morphological Pressure Mapping of Intermittent Pneumatic Compression Therapy.

Intermittent pneumatic compression (IPC) is a proactive compression therapeutic technique in the prophylaxis of deep vein thrombosis, reduction of limb edema, and treatment of chronic venous ulcers. To appropriately detect and analyze biomechanical pressure profiles delivered by IPC in treatment, a dynamic interface pressure monitoring system was developed to visualize and quantify morphological pressure mapping in the spatial and temporal domains in real time. The system comprises matrix soft sensors, a smart IPC device, a monitoring and analysis software, and a display unit. The developed soft sensor fabricated by an advanced screen printing technology was used to detect intermitted pressure by an IPC device. The pneumatic pressure signals inside the bladders of the IPC were also transiently collected by a data acquisition system and then transmitted to the computer through Bluetooth. The experimental results reveal that the developed pressure monitoring system can perform the real-time detection of dynamic pressures by IPC and display the morphological pressure mapping multi-dimensionally. This new system provides a novel modality to assist in the effective evaluation of proactive compression therapy in practice. The study results contribute to understanding the working mechanisms of IPC and improving its functional design based on intuitive biomechanical characteristics of compression delivery profiles.

European guidelines on perioperative venous thromboembolism prophylaxis: Mechanical prophylaxis.

: Institutional protocols need to address the indications for pharmacological and mechanical thromboprophylaxis. The use of graduated compression stockings (GCS) and intermittent pneumatic compression (IPC) strongly differs between institutions. As a consequence, no strong recommendations can be made based on the contemporary high-level evidence. Although different clinical practices can be supported, such approaches should be part of an institutional strategy to reduce the burden of venous thromboembolism (VTE). We recommend against the use of GCS alone without pharmacological thromboprophylaxis for prevention of VTE in patients at intermediate and high risk. For patients at high risk of VTE with contraindications for pharmacological thromboprophylaxis, we recommend the use of mechanical prophylaxis and suggest the use of IPC over GCS. However, for those patients receiving pharmacological thromboprophylaxis who are without a very high risk of VTE prophylaxis, we recommend against the routine use of mechanical thromboprophylaxis either with GCS or IPC. We suggest combined mechanical and pharmacological prophylaxis in selected patients at very high risk of VTE prophylaxis and suggest IPC rather than GCS in these selected patients.

What Factors Influence Compliance With Sequential Compression Devices in an Orthopaedic Unit: A Quality Assurance Observational Study.

The purpose of this study was to determine the compliance rate with sequential suppression devices (SCDs) of patients admitted to an orthopaedic unit of a level I trauma center. A quality assurance observational study was conducted over a 4-week period (June/July 2015). Three observations were performed per 24-hour period (0700, 1300, 1900 hours). ``Full SCD compliance'' was defined as the SCD ordered, on and functioning properly at the time of observation. Of the 1356 observations in 109 patients, 434 (32%) were fully compliant with SCD prophylaxis. SCD compliance in trauma patients was higher (21%) as compared with elective surgical patients (10%) (p < .0001). Morning observations had the highest compliance rate (38.3%), whereas the afternoon (23.5%) and evening observations (33.1%) had less compliance rates (p < .0001). There was a significantly higher compliance rate on weekdays (33.9%) as compared with weekends (28%) (p < .03). The overall low compliance level (32%) indicates compliance challenges and not the modality of the prophylaxis as the cause (Journal of Surgical Orthopaedic Advances 27(4):307-311, 2018).

Effect of Intermittent Pneumatic Compression on Preventing Deep Vein Thrombosis Among Stroke Patients: A Systematic Review and Meta-Analysis.

BACKGROUND: Deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) are common complications of stroke. However, the effect of intermittent pneumatic compression (IPC) for patients after stroke is uncertain. OBJECTIVES: To assess the effectiveness and safety of IPC in reducing the risk of DVT, PE, and mortality in stroke patients. METHODS: We searched leading medical databases including Medline, EMBASE, Cochrane Library, Wanfang, CNKI, and CBM, from inception to June 2, 2017. Studies comparing IPC with no IPC in stroke patients were included. Agreement was measured using simple agreement and kappa statistics. The rates of PE, DVT, and mortality were compared. The results were pooled using a fixed effects model to evaluate the differences between the IPC and control groups. If there was significant heterogeneity in the pooled result, a random effect model was used. RESULTS: We identified seven randomized controlled trials that included 3,551 stroke patients. The average calculated κ for the various parameters was κ = 0.96 (0.70-1). Overall, IPC significantly reduced the incidence of DVT in stroke patients (risk ratio [RR] = 0.50; 95% confidence interval [CI 0.27, 0.94]). At the same time, IPC increased IPC-related adverse events (RR = 5.71; 95% CI [3.40, 9.58]). Though IPC was associated with a significant increase in survival by 4.5 days during 6 months of follow-up (148-152 days; 95% CI [-0.2, 9.1]), there was a mean gain of only 0.9 days (26.7-27.6 days; 95% CI [2.1, 3.9]) in quality-adjusted survival during the 6-month follow-up. Overall, sensitivity analyses did not alter these findings. LINKING EVIDENCE TO ACTION: This review provides an important basis for preventing DVT in stroke patients, especially in hemorrhagic stroke patients. IPC significantly reduces the risk of DVT and significantly improves survival in a wide variety of patients who are immobile after stroke. However, IPC does not significantly improve quality-adjusted survival. Clinicians should take functional status and quality of life into consideration when making decisions for stroke patients.

Intermittent pneumatic compression in patients with ESRD. A systematic review.

INTRODUCTION: Patients with end-stage renal disease (ESRD) experience frequent hemodialysis (HD) complications. Intradialytic hypotension (IDH) is a common complication presenting in approximately between 20 and 50% of HD sessions. Available interventions such as volume replacement or vasoactive medications are associated with significant side effects. Intermittent pneumatic compression (IPC) has been proposed as a feasible intervention for the prevention of IDH, treatment of peripheral arterial disease and venous ulcers. These devices apply intermittent pressure to the legs improving arterial blood flow, mobilization of pooled blood with an increase in venous return increasing the effective circulatory volume. Our goal was to identify the published clinical evidence on whether IPC has a circulatory benefit and is it well-tolerated among patients receiving HD. METHODS: We conducted a systematic review to identify studies assessing the efficacy and safety of IPC in patients with ESRD. Our primary outcome was IDH. Secondary outcomes such as HD comfort, ultrafiltration volume, and physical activity were collected. No restrictions where used and we included all observational and interventional studies. Two reviewers performed screening and study quality assessment. FINDINGS: We included seven studies. Out of the seven studies, five addressed IDH, and the rest were included for secondary outcomes such as physical capacity and HD comfort. In one randomized crossover trial comparing exercise against IPC, 21 patients were randomized to 3 different arms (no intervention, cycling, IPC) a decrease in the rates of IDH with IPC was described (43%, 38%, and 24% respectively P = 0.014). The smaller studies corroborated these results. All studies where at high risk of bias. DISCUSSION: IPC might offer significant benefits for patients undergoing HD not limited to prevention of IDH but also improvement of hemodialysis comfort and physical capacity. However, our results should be interpreted in the context of its limitations.

Intermittent pneumatic compression in fracture and soft-tissue injuries healing.

INTRODUCTION: Current methods of fracture care use various adjuncts to try and decrease time to fracture union, improve fracture union rates and enhance functional recovery. Intermittent pneumatic compression (IPC), one such modality, is used in the management of both fractures and soft-tissue injuries. METHODS AND RESULTS: A search of PubMed, Medline, CINAHL, DH data and Embase databases was performed using the following keywords 'intermittent pneumatic compression', 'fracture healing' and 'soft tissue healing'. Sixteen studies on the use of IPC in fracture and soft-tissue healing were identified. These studies demonstrated that IPC facilitates both fracture and soft-tissue healing with rapid functional recovery. CONCLUSIONS: IPC appears to be an effective modality to enhance fracture and soft-tissue healing. However, the number of subjects in human studies is small, and adequately powered randomized controlled trials in humans are required to produce stronger clinically relevant evidence.

Comparison of a radial artery compression device with invasive radial artery blood pressure monitoring.

OBJECTIVE: The goal of this study was to validate the accuracy of the Primo radial artery compression device (RACD) according to the guidelines recommended by the American National Standards Institute/Association for the Advancement of Medical Instrumentation (AAMI) SP10-2002 Standards for Electronic or Automated Sphygmomanometers. METHODS: A prospective, nonblind, convenience sample trial at a level 1 trauma center (annual emergency department census 70,000) enrolled 17 adult patients with preexisting radial artery line catheters (RAL). Each patient had 10 blood pressure measurements giving an n=170. This number is consistent with calculations on the basis of the American National Standards Institute/AAMI guidelines. RESULTS: The mean arterial pressures (MAPs), systolic blood pressures (SBPs), and diastolic blood pressures (DBPs) measured by both the RACD and the RAL were compared. The R for the RAL/RACD were 0.94, 0.96, and 0.85 for MAP, SBP, and DBP, respectively (P<0.05). The mean difference between the RAL MAP and the RACD MAP was +1.0 mmHg (95% confidence interval, -1.69 to -0.33). The mean SBP difference was -2.8 mmHg (SD 6.4 mmHg) and the mean DBP difference was +2.6 mmHg (SD 5.7 mmHg). CONCLUSION: The RACD meets the guidelines for automated blood pressure monitors set by the AAMI SP10-2002 Standards for Electronic or Automated Sphygmomanometers with an accuracy of +/- 5 mmHg and SD of 8 mmHg or less for both SBP and DBP measurements.

Intermittent pneumatic compression in immobile patients.

The purpose of this study is to stress the value of using intermittent pneumatic compression (IPC) in immobile patients. The use of IPC helps prevent limb oedema and the associated skin changes frequently seen on the legs of the immobile patient. Oedema formation is caused by an increase of fluid extravasation, while skin changes including leg ulcers are mainly because of a deficiency of the venous and lymphatic pumps. Conventional compression stockings and bandages impede leg swelling but are less efficient in supporting the deficient veno-lymphatic pump when patients are unable to move. In this situation, actively compressing the limb using IPC is a very meaningful and effective treatment option. Because of a lack of literature on the specific indication of IPC in immobile patients, experimental studies and randomised controlled trials in similar situations are reviewed. IPC is a very effective although underused treatment modality, especially in immobile, wheelchair-bound patients. By inflation and deflation of the air-filled garments, IPC produces cycles of pressure waves on the leg, thus mimicking the working and resting pressures applied by compression bandages. IPC not only reduces leg swelling but also augments the veno-lymphatic pump, which is essential for the restoration of the damaged microcirculation of the skin.

Investigation of Blood Flow During Intermittent Pneumatic Compression and Proposal of a New Compression Protocol.

INTRODUCTION: Intermittent pneumatic compression (IPC) is now a widely used therapy for the prophylaxis of deep vein thrombosis and pulmonary embolism. In general, the IPC sequence is composed of sequential compression and simultaneous deflation. Typically, veins are considered to be squeezed and emptied during the compression phase and to be refilled during the deflation phase. However, because the stop or sudden increase in blood flow can be dangerous, a further investigation is needed with respect to the blood flow. MATERIALS AND METHODS: We demonstrated a new compression protocol based on the investigation results of venous blood flow during IPC. This new compression protocol involves successive compression without the deflation phase; thus, the expelled blood volume flow during a given period can be maximized. To investigate the blood flow during IPC, sonography movie clips and in-laboratory developed blood flow analysis software was used. RESULTS: The increases in the peak volume flow during IPC were 49% (±24%) and 25% (±29%) with the conventional protocol and the new protocol, respectively, whereas the total volume flow (TVF) was not significantly changed (-1.0% and -13.0%, respectively). With the new protocol, the peak velocity (PV) was 49% lower than that with the conventional protocol. Thus, the new protocol has an effect of maintaining TVF without resulting in a sudden large increase or decrease in PV. CONCLUSION: The new suggested protocol might improve safety because it can maintain the stability of blood flow by reducing the risk of blood stasis and a rapid change in blood flow.

Intermittent pneumatic compression devices.

Intermittent pneumatic compression (IPC) devices are used to aid circulation in the lower limbs as a means of preventing deep vein thrombosis--a condition that can be dangerous and even fatal if it results in a pulmonary embolism. To be effective, IPC devices need to be safe, easy to use, and comfortable. Our Evaluation tells you which products meet these qualifications and how you can select one that best suits your needs. We tested and rated the following products: the VenaFlow, supplied by Aircast/DJO; the Flowtron Excel and Flowtron Universal, supplied by Huntleigh Healthcare; the PlexiPulse and Pulse SC, supplied by Kinetic Concepts Inc. (KCI); the A-V Impulse System, SCD Express, and SCD Response, supplied by Tyco Healthcare/Kendall.

A randomised controlled study of standard versus accelerated deflation of the Terumo radial band haemostasis device after transradial diagnostic cardiac catheterisation.

BACKGROUND: Radial access is the preferential access route in patients undergoing diagnostic coronary angiography. We hypothesised that we could reduce hospital stay and improve patient comfort by accelerated deflation of the radial compression device (Terumo radial band). AIMS: The aim of this study was to compare accelerated pressure reduction with a standard Terumo radial band protocol with regard to local bleeding complications and reported pain scores after cardiac catheterisation. METHODS: We performed a single centre prospective randomised trial to compare accelerated care to standard care for patients undergoing diagnostic catheterisation through radial access. Patients in the accelerated care group started deflation after 1 hour, with a 2 ml/10-minute interval. Patients in the standard care group started after 2 hours with additional steps of deflation at 3 and 4 hours. RESULTS: Of the 173 analysed patients 86 received accelerated care and 87 patients standard care. A total of 19 patients had pulsatile bleeding, which occurred similarly in the two groups (standard care 11 vs. accelerated care 8, P=0.47). The time to Terumo radial band removal was on average 129 minutes shorter for accelerated care patients compared to standard care ( P<0.01). At 1 hour after Terumo radial band placement, accelerated care patients more often reported pain scores of 0 than standard care patients (89% vs. 74%, P=0.02). CONCLUSIONS: There was no increase in local bleedings in the accelerated pressure reduction of the Terumo radial band after diagnostic cardiac catheterisation, increasing patient comfort and reducing hospital stay. These findings will further facilitate the widespread implementation of radial access.

Evaluating an intermittent compression system for thromboembolism prophylaxis.

Patients undergoing orthopaedic or trauma surgery are at high risk of venous thromboembolism, which can lead to deep-vein thrombosis and other complications. However, it is well known that incidence can be greatly reduced with prophylaxis. This article reports on the trial of a new intermittent pneumatic compression device.

Chronic edema of the lower extremities: international consensus recommendations for compression therapy clinical research trials.

Chronic edema is a multifactorial condition affecting patients with various diseases. Although the pathophysiology of edema varies, compression therapy is a basic tenant of treatment, vital to reducing swelling. Clinical trials are disparate or lacking regarding specific protocols and application recommendations for compression materials and methodology to enable optimal efficacy. Compression therapy is a basic treatment modality for chronic leg edema; however, the evidence base for the optimal application, duration and intensity of compression therapy is lacking. The aim of this document was to present the proceedings of a day-long international expert consensus group meeting that examined the current state of the science for the use of compression therapy in chronic edema. An expert consensus group met in Brighton, UK, in March 2010 to examine the current state of the science for compression therapy in chronic edema of the lower extremities. Panel discussions and open space discussions examined the current literature, clinical practice patterns, common materials and emerging technologies for the management of chronic edema. This document outlines a proposed clinical research agenda focusing on compression therapy in chronic edema. Future trials comparing different compression devices, materials, pressures and parameters for application are needed to enhance the evidence base for optimal chronic oedema management. Important outcomes measures and methods of pressure and oedema quantification are outlined. Future trials are encouraged to optimize compression therapy in chronic edema of the lower extremities.

Are sequential compression devices commonly associated with in-hospital falls? A myth-busters review using the patient safety net database.

OBJECTIVES: Sequential compression devices (SCDs) help prevent deep venous thrombosis and pulmonary embolism in hospitalized patients; however, clinicians often decline to use this therapy because of a perceived increased risk for patient falls. There is limited information regarding the association between the use of SCDs and patient falls. In this study, we analyze if SCD use is a common risk factor for in-hospital falls. METHODS: We used the Patient Safety Net event reporting system at our university-affiliated hospital to retrospectively quantify reports of SCD-related falls over a nearly 5-year period (July 1, 2004, through May 25, 2009). The primary outcome was to determine how often SCD-related falls occurred in relation to SCD patient days. Secondary aims of this study included an assessment of the severity of SCD-related falls, as well as potential risk factors for such falls. RESULTS: Three thousand five hundred sixty-two total falls were reported during our study period, 16 of which (0.45%) were SCD-related falls. There were 0.063 SCD-related falls per 1000 SCD patient days or 1 fall for every 15,774 SCD patient days. The mean age of patients was 57.8 ± 14.4 years, 69% were male subjects, 81% were on a surgical ward, and 69% occurred while attempting to toilet. Only 2 of the SCD-related falls caused temporary harm that required intervention. CONCLUSIONS: Sequential compression device use is rarely associated with in-hospital patient falls, and SCD-related falls are not more harmful than other types of falls.

[Strategy and results of pneumatic compression following transfemoral catheterization]. / Strategie und Ergebnisse der pneumatischen Kompression nach transfemoraler Katheterisierung.

BACKGROUND AND OBJECTIVE: Transfemoral arterial access of catheterization requires a method of hemostasis that is always easily and quickly applicable, but also safe, inexpensive and comfortable for the patient. Current methods meet these requirements only in part. The pneumatic pressure-controlled FemoStop system has been described as straightforward and safe. But the conventional procedure has been to achieve primary hemostasis with FemoStop and then switch to a pressure bandage. We here present our method of using FemoStop alone for the entire duration of the compression and compare the results with those of manual compression. PATIENTS AND METHODS: The preferred methods of managing the arterial puncture site in our center were compared for two different periods. Group MC (manual compression) comprised 1,085 patients (mean age 63.310.5 years, 29.8% females) in whom manual compression had been applied followed by a pressure bandage. Group FS (pneumatic compression) comprised 1,087 consecutive patients (mean age 64.610.7%, 35.1% females) in whom pneumatic compression only had been applied. The incidence of pseudoaneurysms, a-v fistulas and bleeding requiring transfusion were compared. RESULTS: The incidence of pseudoaneurysms after diagnostic cardiac catheterization in the FS group was lower than in the MC group. In patients after an angioplasty the results were similar other than the time the patient has to remain in bed. The incidence of a-v fistulas was similar in the two groups. There was only one episode pf bleeding that required transfusion (MC group). A multivariate analysis indicated that female gender is an independent risk factor for the occurrence of pseudoaneurysms and a-v fistulas. CONCLUSIONS: The FemoStop system used by itself took less time than manual compression and was associated with a slightly lower risk of complications.

Prevention of venous thrombosis in patients with acute intracerebral hemorrhage.

OBJECTIVE: To assess intermittent pneumatic compression (IPC) in the prevention of venous thromboembolism (VTE). METHODS: The authors randomly allocated patients with a documented intracerebral hemorrhage (ICH) to elastic stockings (ES) alone or combined with IPC. The primary outcome was a combined criteria assessed at day 10: a symptomatic and well-documented VTE, or a death arising before day 10 and related to pulmonary embolism (PE), or an asymptomatic deep vein thrombosis (DVT) of the lower limbs detected by compression ultrasonography (CUS). Outcome assessment was blinded. RESULTS: One hundred fifty-one patients were randomized; 133 (88%) patients were evaluated at day 10. No clinical suspicion of VTE arose before day 10. Fourteen patients died before having a CUS but no death was definitely related to PE. Fourteen asymptomatic DVT were detected by CUS: three (4.7%) in the ES + IPC group (all distal) and 11 (15.9%) in the ES group (three proximal and eight distal). ES combined with IPC is associated with a reduced risk of asymptomatic DVT compared to ES alone: relative risk, 0.29 (95% CI 0.08 to 1.00). CONCLUSIONS: Asymptomatic deep vein thrombosis (DVT) was detected at day 10 in 15.9% of patients wearing elastic stockings alone. Intermittent pneumatic compression significantly decreased the occurrence of asymptomatic DVT for patients with intracerebral hemorrhage.

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)