Can I apply sequential compression devices (SCDs) on the left leg of a patient with a deep vein thrombosis (DVT) in the right leg?

Sequential Compression Device Use in Patients with Unilateral DVT

Yes, you can safely apply sequential compression devices (SCDs) on the unaffected left leg of a patient with a right leg deep vein thrombosis (DVT). 1

Rationale for SCD Use in the Unaffected Limb

• SCDs function by artificially replicating the "pumping mechanism" of the soleus muscle to enhance venous return and reduce stasis, which helps prevent DVT formation in the unaffected limb 2
• When one leg has a DVT, the contralateral leg remains at risk for thrombosis development, making prophylaxis important 1
• Current guidelines recommend anticoagulation as the primary treatment for DVT, but mechanical prophylaxis in the unaffected limb provides additional protection 1

Management Algorithm for Patients with Unilateral DVT

1. Primary treatment for the affected leg with DVT:

   • Initiate anticoagulant therapy as the mainstay of treatment 1
   • Consider early ambulation as tolerated rather than strict bed rest 1
   • Avoid applying SCDs to the leg with confirmed DVT

2. Prophylaxis for the unaffected leg:

   • Apply SCDs to the contralateral (unaffected) leg to prevent DVT formation 3, 2
   • Ensure proper fit and functioning of the device 4
   • Monitor for patient compliance with the device 4

Effectiveness and Considerations

• SCDs have been shown to effectively reduce DVT risk with a low failure rate (3-8%) when properly applied 3
• Sequential compression is more effective than uniform compression in enhancing venous flow velocity and volume 5
• Patient compliance is a critical factor in SCD effectiveness - devices are only functioning properly in about 53% of observations in hospitalized settings 4

Important Clinical Pearls

• Check the unaffected leg regularly for signs of DVT development (pain, swelling, warmth) 1
• Ensure the SCD is properly fitted and functioning at regular intervals throughout the day 4
• The most common times for non-compliance with SCD use are early afternoon and midmorning - extra vigilance during these times may be beneficial 4
• Consider supplementing mechanical prophylaxis with pharmacological prophylaxis in high-risk patients, when not contraindicated 2

Contraindications to SCD Use

• Do not apply SCDs to legs with:
  • Confirmed DVT 1
  • Severe peripheral arterial disease 6
  • Recent skin grafts 6
  • Dermatitis or open wounds 6

By applying SCDs to the unaffected left leg while treating the right leg DVT with appropriate anticoagulation, you provide comprehensive thromboprophylaxis that addresses both the existing thrombosis and prevents new clot formation.