A clinical comparison of pneumatic compression devices: The basis for selection

Purpose. The five pneumatic compression devices (PCDs) that are marketed pr ovide mechanical protection from deep venous thrombosis (DVT). They differ with respect to patterns of compression and the length of the sleeve. Evide nce linking differences to clinical outcomes is lacking. Our purpose was tw ofold: to evaluate each of the marketed PCDs with respect to effectiveness, compliance, and patient and nursing satisfaction and to determine whether there is a clinical basis for the selection of one device over another. Methods. Each of the marketed devices was used exclusively for a 4-week per iod. Patients participated in an evaluation including venous duplex ultraso und scan, DVT risk assessment, and device evaluation. Vascular laboratory r ecords were used to document DVT. Compliance was measured by meters install ed on all pumps. A ranking matrix was stratified by compression pattern: ra pid graduated sequential compression, graduated compression, and intermitte nt compression, and each device was rated by patients and nurses. Results. The PCDs were used in 1350 cases with a DVT rate of 3.5% ranging f rom 2% to 9.8% depending on the method of compression. Patients with DVT we re older (58 vs 54 years), had better compliance (67% vs 50%), and had more compression days (11 vs; 7.2). When thigh-length sleeves were used, a grea ter proportion of DVT occurred in the proximal segments (71%) as compared w ith the number of proximal DVT when the calf-length devices were used (52%; P=.21). Devices W, X, and Y had comparable rates of DVT, which were lower than those for V and Z. Compression device Y, with calf and thigh sleeves, achieved the best overall ranking largely because of high scores for patien t and nurse satisfaction. Conclusion: Our data appear at odds with commonly held beliefs. We were una ble to show a difference in DVT incidence based on the length of the device or the method of compression. Randomized studies are needed to confirm our findings and evaluate hypotheses derived from this study.