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Keywords

critical care, deep vein thrombosis, intermittent pneumatic compression devices, mechanical ventilation, pulmonary embolism, thromboprophylaxis, venous thromboembolism

 

Authors

  1. Elpern, Ellen MSN, APN
  2. Killeen, Kathryn MSN, APN
  3. Patel, Gourang PharmD, MS
  4. Senecal, Pol Andre BSN, RN

Abstract

Objective: Because venous thromboembolism (VTE) can be a devastating consequence of critical illness, patients should receive thromboprophylaxis using chemical or mechanical strategies or both. Mechanical strategies such as intermittent pneumatic compression (IPC) devices are in widespread use; this study sought to assess clinicians' adherence to ordered IPC devices in critically ill patients.

 

Methods: A month-long prospective, observational study was conducted in a convenience sample of 108 mechanically ventilated patients in four adult ICUs in an urban academic medical center. Observations of prescribed IPC device applications were made twice daily by nurses using a standardized checklist.

 

Results: Nine hundred sixty-six observations were made of 108 patients, 47 (44%) of whom were ordered to receive thromboprophylaxis with IPC devices alone and 61 (56%) to receive IPC devices in combination with an anticoagulant. Errors in IPC device application were found in 477 (49%) of the observations. Patients received no IPC prophylaxis in 142 (15%) of total observations. In 45 of 342 (13%) of the observations, IPC devices were the only type of thromboprophylaxis ordered. Half of the misapplications related to improper placement of sleeves to legs. Misapplications did not differ in type or frequency between shifts.

 

Implications: The researchers observed frequent misapplications of ordered IPC devices. Future study is necessary to illuminate the consequences of such errors.