- Can be worn on the bare leg or over pyjamas or thin trousers
- Lay flat under leg, then wrap around
- Tight enough, so just two fingers can fit underneath sleeve at knee
The following video shows the correct application of the IPC sleeves.
Category: Advancing Modules
Selecting the correct size of IPC Sleeves
The CLOTS 3 trial only tested SCD Express thigh length sleeves. We have no information in stroke patients about the effectiveness of compression of the calf or foot only.
- The SCD system provided 4 sizes of thigh length sleeves (X small, small, medium & large)
- Based on single measurement of thigh circumference – at its widest point
| Sizing the SCD express sleeves | |
|---|---|
| Thigh circumference | Size of sleeve |
| < 16 inches, 40.6 cm | X small |
| 16-22 inches, 46-56 cm | Small |
| 22-28 inches, 56-71 cm | Medium |
| 28-36 inches, 71-92 cm | Large |
The following video illustrates how to size Kendall’s SCD IPC sleeves.
How long should we apply IPC?
- As soon as possible after admission
- For up to 30 days
- Day and Night if possible
- Take off during bathing but remember to re-apply afterwards
- Can be taken off during therapy sessions but remember to re-apply afterwards
- Don’t worry about interruptions in IPC treatment and if patients only tolerate IPC during the day and remove overnight, that is better than no IPC
The CLOTS 3 trial only tested IPC for the first 30 days because this is the period when the risk of DVT is highest. It is generally recommended to remove IPC at 30 days. However, if the patient remains immobile beyond 30 days and then becomes unwell with infection or dehydration it would be logical to re-apply IPC until these additional risk factors have been effectively treated. This strategy has not been tested in a randomised trial.
Which patients should be treated with IPC?
IPC is suitable for:
- Patients who cannot walk to toilet unaided
- Patients in whom the aim of treatment is to improve survival
IPC is not suitable for:
- Patients receiving ‘end of life’ or palliative care
- Patients with bad oedema due to heart failure
- Patients suffering from skins problems on both legs (can use on one leg)
- Severe peripheral vascular disease
- Patients who are trying to mobilise against advice who are at risk of falling
Kendall SCD Express system
The RCTs which have shown that IPC are effective in stroke have used Kendall SCD Express which provides:
- Thigh-length
- Sequential
- Circumferential
- Slow inflation
- Frequency depends on venous refill
- With standard or comfort sleeves
Types of IPC
A number of manufacturers produce IPC devices. The devices are of different types and vary in ways which may influence how effective they are.
- Thigh length which compress the calf and thigh, calf only and foot only
- Sequential or Single compression – some systems squeeze the lower calf, then upper calf, then thigh to milk the blood out of the leg – others squeeze all together
- Some squeeze around the circumference of the leg, others press just the back
- Slow or fast inflation
- Fixed frequency compression or frequency controlled by rate of venous filling
- Various styles and materials of sleeves which might influence patient comfort, and therefore adherence.
The CLOTS 3 trial tested the Kendall SCD Express system
Intermittent Pneumatic Compression (IPC)
What does IPC comprise?
- Intermittently squeezes the legs which increases the flow of blood in the deep veins
- The CLOTS-3 trial showed that it reduces the risk of DVT in stroke patients (link to evidence)
- Is effective in ischaemic & haemorrhagic stroke
- The trial also showed that patients receiving treatment with IPC were more likely to survive
- Should be used unless the patient is considered to have a poor prognosis and receiving palliative care
Patients at 6 month follow up in the CLOTS 3 trial
The Oxford handicap scale is a measure of disability, ranging from 0 (no symptoms) through to 5 (bed-bound and incontinent) and 6 (dead). There was no statistically significant difference in the Oxford handicap scale between those allocated IPC and No IPC. However there is a 3% reduction in the proportion who have died at the final follow up in the IPC arm. Also there is a 4% increase in the proportion surviving with severe disability with IPC. This issue is discussed in the Lancet neurology paper.
Probability of death within 6 months
Patients allocated IPC had a lower hazard of death (increased chance of survival) during the first six months after enrolment compared to those allocated to routine care.
CLOTS 3 – Efficacy 30 day VTE outcomes
Patients allocated IPC had a reduced risk of:
- Proximal (above knee) DVT
- Symptomatic DVT (above or below knee)
- Any DVT (including symptomatic and asymptomatic DVT, above and below the knee)
- The reduction in risk of PE was not statistically significant
