Semiautomatic intermittent pneumatic compression device applied to deep vein thrombosis in major orthopedic surgery

Precision nursing and intermittent pneumatic compression significantly reduce perioperative deep vein thrombosis in post-surgical ovarian cancer patients

OBJECTIVE

This study investigated the efficacy of precision nursing combined with intermittent pneumatic compression (IPC) devices in preventing perioperative deep vein thrombosis (DVT) in patients with ovarian cancer.

METHODS

A retrospective analysis was conducted on 136 ovarian cancer surgery patients at Xi'an People's Hospital from February 2019 to April 2023. The patients were divided into two groups: 71 patients received precision nursing with IPC intervention (study group), while the remaining received standard nursing care (control group). Key variables analyzed included operation duration, intraoperative blood loss, postoperative blood transfusion requirements, changes in limb circumference, and variations in coagulation parameters activated partial thromboplastin time (APTT), D-Dimer (D-D), Fibrinogen (FIB), and Prothrombin Time (PT) before and after surgery. The incidence of DVT was recorded in both groups to determine risk factors for deep vein thrombosis.

RESULTS

No significant differences were observed between the groups regarding operation duration, intraoperative blood loss, and postoperative blood transfusion rates (P > 0.05). Post-intervention, significant improvements were noted in the study group, with reduced FIB and D-D levels and increased PT and APTT levels compared to the control group (P < 0.05). Furthermore, the study group exhibited a significantly smaller post-intervention difference in limb circumference and a lower incidence of DVT (P=0.003). Precision nursing combined with IPC, pre-intervention D-D < 498.5, and FIGO stages III+IV were identified as independent factors against DVT development.

CONCLUSION

Precision nursing paired with an IPC device significantly reduces the risk of perioperative DVT in ovarian cancer patients compared to conventional care.

Preferências e práticas de ortopedistas brasileiros por técnicas de tromboprofilaxia na artroplastia total do joelho: Levantamento entre membros da Sociedade Brasileira de Cirurgia do Joelho (SBCJ)

Objetivo Descrever as preferências e práticas atuais de uma amostra de cirurgiões de joelho do Brasil quanto à forma de tromboprofilaxia na artroplastia total do joelho (ATJ).

Método Na presente pesquisa realizada pela internet, cirurgiões associados à Sociedade Brasileira de Cirurgia do Joelho (SBCJ) foram convidados a responder voluntariamente a um questionário anônimo incluindo o tempo de experiência cirúrgica pessoal, percepções sobre as melhores opções de tromboprofilaxia e as reais práticas no ambiente onde trabalham.

Resultados Entre dezembro de 2020 e janeiro de 2021, 243 participantes responderam ao questionário completo. Exceto por 3 (1,2%) participantes, todos declararam praticar tromboprofilaxia, a maioria (76%) combinando as formas farmacológica e mecânica. A droga mais prescrita é a enoxaparina (87%), com modificação para rivaroxabana (65%) após a alta. O momento de início da tromboprofilaxia variou conforme o tempo de formação do cirurgião de joelho (p ≤ 0,03) e as preferências e práticas variaram conforme a região do país (p < 0,05) e o sistema de saúde no qual trabalham os cirurgiões (público ou privado; p = 0,024). A opção por tromboprofilaxia mecânica também dependeu do tempo de formação do cirurgião.

Conclusão As preferências e práticas de tromboprofilaxia na ATJ são diversas nas regiões do Brasil e sistemas de saúde (público ou privado). Dada a inexistência de uma diretriz clínica nacional, a maior parte dos ortopedistas segue ou a diretriz de seu próprio hospital ou nenhuma. O método de profilaxia mecânica e a pouca utilização do ácido acetilsalicílico são os pontos que mais destoam das diretrizes e práticas internacionais.

Hemodynamic analysis of intermittent pneumatic compression combined with hyperthermia after total hip arthroplasty: an experiment on male rabbits

OBJECTIVE

To investigate the effect of intermittent pneumatic compression combined with hyperthermia (IPCH) on the hemodynamic changes in lower limbs of male rabbits and to clarify whether its efficacy is superior to that of intermittent pneumatic compression (IPC) or hyperthermia (HT) alone.

METHODS

Thirty male adult New Zealand white rabbits with a body mass of 2.6±0.3 kg were obtained to establish a model of postoperative hypercoagulable state by simulating left hip surgery. Then they were randomly divided into HT group, IPC group, and IPCH group. Relevant hemodynamic parameters were examined by color Doppler ultrasound before and after treatment. A femoral vein finite element model was established according to fluid mechanics to analyze the blood flow velocity distribution vector, total deformation, equivalent stress of the femoral vein and venous valve.

RESULTS

The heart rate, blood flow per minute, and mean and peak blood velocity of the femoral vein in IPCH group were significantly higher than those in HT and IPC groups (P<0.05). There was no significant difference in venous diameter (P>0.05). The blood flow velocity distribution vector, the total deformation of femoral vein, and the equivalent stress between femoral vein and venous valve in the IPCH group were higher than those in HT and IPC groups, but the total deformation of venous valve was smaller in IPCH group.

CONCLUSIONS

IPCH superimposes the effects of IPC and HT, and can more effectively promote changes in local blood circulation to prevent deep vein thrombosis.

Effects of different intensities of intermittent pneumatic soft-tissue compression on bone defect repair

Background

To estimate the effects of different intensities of intermittent pneumatic soft-tissue compression on bone defect repair in an animal model.

Methods

Five mm radial bone defect in length was made in 64 mature New Zealand rabbits and all animals randomly assigned into four groups: Group A (control group without compression), Group B (5–7 kPa intensity), Group C (8–10 kPa intensity) and Group D (11–13 kPa intensity). On the fourth day after surgery, their legs were intermittently pneumatic compressed for 4 weeks. The stimulation lasted 30 min every day and the frequency of compression was 15 Hz. New bone formation in 4 groups was evaluated by gross observation, X-ray, Micro-CT, and histological staining at 2 and 4 weeks after surgery.

Result

There was more new bony callus in the bone defect in group C than in other groups by gross observation and X-ray radiography at 2 and 4 weeks. The Micro-CT results showed more new bony callus, bone trabecula and higher bone mineral density in group C. Fluorescent labeling results showed the speed of new bone formation in Group C was faster than that in other groups, among which the control group had the slowest speed of new bone formation. The result of histology had shown that the trabeculae in bone callus in group C had a regular form, the trabeculae were wide and had a more become osteoblast around them.

Conclusion

The intermittent pneumatic soft-tissue compression can accelerate new bone formation of bone defects and the optimal intensity is 8–10 kPa for repairing the rabbit radial bone defect.

Effect of Active and Passive Mechanical Thromboprophylaxis and Consensual Effect on the Venous Blood Flow Velocity Among Hemiparetic Patients

Our aim was to measure the venous blood flow velocity (VBFV) in case of hemiparetic patients, after passive and active thromboembolic methods, as well as the consensual effect in the hemiparetic limb following the active venous exercises in the healthy limb. We examined 215 patients, with the median age of 58.0 (55.0-63.0) years. The VBFV was measured with a HADECO BIDOP ES-100 V II type Doppler ultrasound device, using an 8 MHz head, on the femoral vein at the level of the hip joint. For statistical analysis, SPSS version 22 was used. After passive movement, on the hemiparetic side, compared to the value in resting state, the VBFV significantly (12.6; 11.6-13.5 cm/s; P < .001) increased. Following active venous exercises performed on the healthy side, the VBFV significantly (18.0; 15.6-19.6 cm/s; P < .001) increased compared to the value in resting state. Following the active venous exercises performed on the healthy side, the VBFV measured on the hemiparetic side (consensual effect) was significantly (15.1 [14.1-16.5] cm/s; P < .001) higher than the value on the hemiparetic side in resting state. Active and passive mechanical thromboprophylaxis methods can be effective. Movements of the healthy limb significantly increase the VBFV in the inactive limb, and patients can perform it themselves several times a day.