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Correspondence  |   October 2000
Combination of Two Standard Pneumatic Calf Compression Devices to Fit the Morbidly Obese
Author Notes
  • Assistant Professor of Anesthesiology
  • Associate Clinical Professor of Anesthesiology
  • Associate Professor of Anesthesiology
  • Department of Anesthesiology
  • VA Connecticut Healthcare System
  • Yale University School of Medicine
  • New Haven, Connecticut
  • maximilian.hartmannsgruber@yale.edu
Article Information
Correspondence
Correspondence   |   October 2000
Combination of Two Standard Pneumatic Calf Compression Devices to Fit the Morbidly Obese
Anesthesiology 10 2000, Vol.93, 1159. doi:
Anesthesiology 10 2000, Vol.93, 1159. doi:
To the Editor:—
Morbidly obese patients undergoing procedures with general anesthesia are at increased risk for deep venous thrombosis (DVT) and subsequent pulmonary embolism. Because of the extreme lower extremity dimension in these patients, properly fitting pneumatic compression devices for the prevention of DVT may not be available. We describe how this problem can be resolved by the combination of two standard-size pneumatic compression cuffs for which inflation is regulated by a single pump.
A 50-yr-old man was scheduled for elective ventral hernia repair during general anesthesia. The patient had multiple high risk factors for the development of DVT: history of DVT, chronic lower extremity phlebitis, morbid obesity (245 kg), and anesthesia was anticipated to last longer than 30 min. 1 Immediately before the procedure, it was noted that the standard-size Flowtron pneumatic compression cuff (Huntleigh Healthcare, Manalapan, NJ) was too small for the circumference of the patient’s calf. Because it was believed to be important to provide this regimen of prophylaxis in the patient, two standard-size Flowtron single-chamber cuffs were joined using Velcro closures (Velcro Industries B.V., Manchester, NH) and applied to each calf (Fig. 1).
Fig. 1. Combination of two standard-size calf Flowtron single-chamber cuffs using Velcro closures.
Fig. 1. Combination of two standard-size calf Flowtron single-chamber cuffs using Velcro closures.
Fig. 1. Combination of two standard-size calf Flowtron single-chamber cuffs using Velcro closures.
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The two hoses from this assembly were then connected to the two hoses of a Flowtron pump. Because the Flowtron pump alternates inflation between the two hoses, this approach created a dual-chamber sequential cuff and allowed for proper fitting to the large-circumference calf. Postoperatively, the patient was administered subcutaneous heparin for DVT prophylaxis. Clinical signs of DVT or pulmonary embolism were not observed in this patient throughout his 5-day hospital stay and 2-month follow-up period.
Pneumatic compression is a safe and cost-effective method that is equally as effective as heparin for the prevention of DVT. 1 Compression therapy augments peak venous velocity in the deep venous system by 87–302%, reduces stasis, and stimulates intrinsic thrombolytic activity. 2,3 To evaluate the effectiveness of compression therapy using the aforementioned combination of two standard-size Flowtron single chamber cuffs, Doppler flow velocities were measured in a morbidly obese volunteer (213 kg; calf circumference, 56 cm). The positive effect of this approach was confirmed; peak venous velocity was augmented from 19.1 to 31.4 cm/s (164%) per compression in the femoral vein and from 11.0 to 30.6 cm/s (278%) per compression in the greater saphenous vein.
In conclusion, the approach we describe allows for effective pneumatic compression therapy in morbidly obese patients in whom standard-size compression cuffs are inadequate.
References
Soderdahl DW, Henderson SR, Hansberry KL: A Comparison of intermittent pneumatic compression of the calf and whole leg in preventing deep venous thrombosis in urological surgery. J Urol 1997; 157: 1774–6Soderdahl, DW Henderson, SR Hansberry, KL
Westrich GH, Specht LM, Sharrock NE, Windsor RE, Sculco TP, Haas SB, Trombley JF, Peterson M: Venous haemodynamics after total knee arthroplasty. Evaluation of active dorsal to plantar flexion and several mechanical compression devices. J Bone Joint Surg (Br) 1998; 80-B: 1057–66Westrich, GH Specht, LM Sharrock, NE Windsor, RE Sculco, TP Haas, SB Trombley, JF Peterson, M
Camerota AJ, Chouhan V, Harada RN, Sun L, Hosking J, Veermansunemi R, Camerota AJ Jr, Schlappy D, Rao AK: The fibrinolytic effects of intermittent pneumatic compression: Mechanism of enhanced fibrinolysis. Ann Surg 1997; 226: 306–13Camerota, AJ Chouhan, V Harada, RN Sun, L Hosking, J Veermansunemi, R Camerota, AJ Schlappy, D Rao, AK
Fig. 1. Combination of two standard-size calf Flowtron single-chamber cuffs using Velcro closures.
Fig. 1. Combination of two standard-size calf Flowtron single-chamber cuffs using Velcro closures.
Fig. 1. Combination of two standard-size calf Flowtron single-chamber cuffs using Velcro closures.
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