Sequential Compression Devices in Comfort Care
Sequential Compression Devices (SCDs) should be discontinued in patients on comfort care as they do not align with the goals of palliative care and may cause discomfort without providing meaningful benefit to quality of life.
Rationale for Discontinuation
SCDs are primarily used for venous thromboembolism (VTE) prevention, but when a patient transitions to comfort care, the focus shifts from preventive measures to symptom management and quality of life 1.
Patients often report discomfort with SCDs, particularly thigh-length devices, which can cause heat intolerance, itchiness, and sleep disturbance - symptoms that directly contradict comfort care goals 1, 2.
In comfort care settings, interventions should prioritize patient comfort and dignity rather than prevention of long-term complications 1.
Patient Experience Considerations
Studies show that many patients find SCDs uncomfortable, with complaints of heat intolerance (43%) and sleep disturbance (28-57%) 1.
Thigh-length SCDs in particular have higher rates of discomfort compared to knee-length devices, with patients reporting restricting bands and general discomfort 2.
Even in non-comfort care settings, patient compliance with SCDs is poor (only 19% full compliance in one study), indicating they are not well-tolerated even when medically indicated 3.
Medical Rationale
The primary purpose of SCDs is prevention of future complications (DVT/PE), which is inconsistent with the palliative approach that focuses on present comfort rather than future risk prevention 4.
When discussing end-of-life issues and device management, European Society of Cardiology guidelines recommend considering the discontinuation of interventions that do not contribute to immediate comfort 1.
The effectiveness of SCDs in preventing VTE events has been questioned even in general medical patients, with one study showing no significant difference in VTE incidence between patients with SCDs and those without prophylaxis 5.
Approach to Discontinuation
When transitioning a patient to comfort care, all preventative measures including SCDs should be reassessed based on whether they contribute to the patient's comfort 1.
Explain to family members that removing SCDs will not cause immediate harm and may actually improve patient comfort by eliminating a source of potential discomfort 1, 2.
Document in the medical record that SCDs are being discontinued as part of the comfort care plan, with the rationale that they do not contribute to symptom management or quality of life 1.
Special Considerations
If a family expresses strong preference for continuing SCDs, consider a time-limited trial with scheduled reassessment of any signs of discomfort (agitation, restlessness, attempts to remove the devices) 1.
If SCDs must be continued for any reason, knee-length devices are preferable as they cause less discomfort than thigh-length devices 2.
Remember that the goal of comfort care is to maximize quality of life and minimize burdensome interventions that do not contribute to comfort 1.