Contraindications for Sequential Compression Devices (SCDs) in Leg Edema
Sequential compression devices (SCDs) should not be used in patients with leg conditions such as dermatitis, gangrene, severe edema, venous stasis, severe peripheral vascular disease, postoperative vein ligation or grafting, and existing swelling or other signs of an existing deep vein thrombosis (DVT). 1
Absolute Contraindications
- Confirmed deep vein thrombosis (DVT): Using SCDs in patients with existing DVT can potentially dislodge clots, leading to pulmonary embolism 1
- Severe peripheral arterial disease: Patients with ankle-brachial index <0.6 should not receive compression therapy as it indicates arterial anomaly requiring revascularization 1
- Dermatitis or skin breakdown: Compression can worsen skin conditions and lead to further tissue damage 1
- Gangrene: Compression may further compromise already compromised tissue 1
- Recent skin grafts or vein harvesting: These areas need to heal without external pressure 1
- Severe leg edema: Excessive swelling can be worsened by external compression 1
Relative Contraindications
- Moderate peripheral arterial disease: For patients with ankle-brachial indices between 0.6-0.9, reduced compression to 20-30 mmHg may be used with caution 1, 2
- Pulmonary edema: Fluid mobilization from legs can worsen cardiac overload 3
- Congestive heart failure: Rapid fluid shifts may exacerbate cardiac symptoms 2
- Lower extremity fractures: These may preclude the use of standard SCDs, though foot pumps may be considered as an alternative in these cases 4
Special Considerations
- Upper extremity use: SCDs are not recommended for use on arms with peripherally inserted central venous catheters (PICCs) as they may increase the risk of upper extremity DVT 5
- Immobile stroke patients: While SCDs are beneficial for DVT prevention in immobile stroke patients, they should still be avoided if any of the above contraindications are present 6, 1
Alternative Approaches
- For patients with lower extremity injuries: Foot pumps may be considered as an alternative when SCDs cannot be used due to lower extremity fractures or soft tissue injury 4
- For patients with contraindications to both mechanical and pharmacological prophylaxis: Consider IVC filters in select high-risk patients, particularly those with multiple trauma 3
Monitoring Recommendations
- Regular skin assessment: Check for signs of skin breakdown, especially in patients with fragile skin 2
- Proper sizing and fit: Ill-fitting compression devices can cause pressure injuries or be ineffective 2
- Reassessment of contraindications: As a patient's condition changes, contraindications may resolve or develop 7
Remember that while SCDs are valuable for DVT prophylaxis in many patients, their inappropriate use in contraindicated conditions can lead to serious complications including tissue damage, worsening of edema, or even embolization of existing clots 1, 7.