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| Project | Summary of evidence | Evidence level | Recommended level |
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| Pretreatment evaluation |
| Risk assessment | (1) The risk factors for VTE in trauma patients include spinal cord injury, head injury, lower limb fracture, pelvic fracture, need for surgical intervention, age ≥40 years old, femoral vein intubation, venous injury, ventilator use days >3 days, long-term braking, extended hospital stay, and high injury severity score. | 4a | B |
| (2) Assessment content of bleeding risk. (1) Patient factors: age, body mass, liver and kidney function, coagulation function, etc. (2) Primary diseases. (3) Complicated diseases (uncontrolled hypertension, active bleeding, history of massive hemorrhage disease, etc.). (4) Combined medication (antiplatelet drugs, anticoagulant drugs or thrombolytic drugs, etc.). (5) Whether there is invasive operation or surgery. | 5b | B |
| (3) VTE risk assessment and bleeding risk assessment should be carried out regularly for trauma patients, at least once every 48 hours; every time the clinical condition changes, re-evaluate at least every day. It is recommended that trauma patients use the Caprini scale or RAPT scale. | 1b | A |
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| Diagnostic assessment | (4) Before taking VTE preventive measures, for patients suspected of DVT or pulmonary embolism, the risk assessment scale of VTE can be used to make a preliminary diagnosis, and then the exclusion diagnosis can be made according to D-dimer. For patients at high risk of DVT, ultrasound examination is preferred. For patients with uncertain or infeasible ultrasound evaluation, computed tomography venography, magnetic resonance venography, or venography should be considered; for patients with high risk of pulmonary embolism, the diagnosis needs pulmonary artery imaging results (such as CT pulmonary angiography, magnetic resonance angiography, or digital subtraction angiography). | 1c | B |
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| Contraindication and applicable conditions |
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| Contraindication | (5) Contraindications should be routinely screened before application. (1) Severe leg edema or pulmonary edema caused by heart failure and congestive heart failure. (2) Suspect or confirm peripheral vascular disease. (3) Peripheral nerve or other sensory disorders. (4) Abnormal local conditions of lower extremities (such as dermatitis, gangrene, recent skin transplantation, open injury, and crush injury), severe arterial disease of lower extremities, other ischemic vascular diseases, and severe deformity of lower extremities. (5) Patients with deep venous thrombosis, thrombophlebitis, or pulmonary embolism should not receive IPC treatment. (6) Allergic to IPC device. | 1a | A |
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| Applicable conditions | (6) VTE risk is low. It is recommended to apply IPC for mechanical prevention. | 2c | A |
| (7) VTE risk is moderate, without high bleeding risk. It is recommended to use drug prevention or mechanical prevention, and drug prevention is preferred; for patients with high bleeding risk or extremely serious bleeding consequences, it is recommended to apply IPC for mechanical prevention. | 2c | A |
| (8) The risk of VTE is high, without high bleeding risk. It is recommended to recommend drug prevention combined with mechanical prevention; for patients with high bleeding risk or extremely serious bleeding consequences, it is recommended to apply IPC for mechanical prevention. | 1b | A |
| (1) For VTE high-risk trauma patients (such as surgical patients with acute spinal cord injury, brain injury, and spinal injury), drug prevention combined with IPC prevention is recommended if there is no contraindication, and IPC prevention is recommended if there is contraindication for drug prevention. | 1b | A |
| (2) For patients with high risk of bleeding (craniotomy, traumatic brain injury, spinal cord injury repair, major trauma, coagulation dysfunction, etc.) or patients with contraindications for drug thrombosis prevention (such as active hemorrhage and intracranial hemorrhage) or patients with hemodynamic instability caused by these conditions, drug prevention should be stopped and IPC mechanical prevention should be used. | 2c | A |
| (3) For patients who cannot move and are at risk of bleeding, it is recommended to use IPC for early mechanical thrombosis prevention. | 1c | A |
| (9) When the bleeding risk of patients with high risk of VTE is reduced, it is recommended to combine drugs and IPC for thrombus prevention within 24 hours after bleeding control until the patient can move. | 1b | B |
| (10) For patients who are undergoing lower limb amputation and contraindication of drug prevention or patients who are unable or unfit to take mechanical preventive measures on the affected side of the limb, consider IPC mechanical prevention on the opposite side of the leg at the time of admission, until the patient’s mobility has improved. | 1b | B |
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| Treatment strategy |
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| Informed consent | (11) It is recommended to inform patients and their families in writing and obtain informed consent before applying IPC. | 5b | B |
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| Limb assessment | (12) Assess the skin hygiene, skin temperature, blood flow, dorsalis pedis artery pulsation, limb sensation, etc. of the lower limb every day, measure the leg circumference, and especially focus on the patients with decreased mobility or impaired skin integrity. | 5b | B |
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| Device evaluation | (13) Regularly check the IPC function status, patient comfort, performance, structural quality, battery-related functions (if equipped with batteries), and easy setting and other easy-to-use functions. | 1b | B |
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| Device selection | (14) Different types of IPC equipment differ in the number of air bags, compression cycle mode, inflation and deflation time, cuff pressure, cuff configuration, and portability. There are basically five different cuff configurations for lower limbs: foot compression, foot and calf compression, calf compression, calf and thigh compression, and whole limb compression. | 1b | B |
| (15) When selecting a specific IPC device, pay attention to the comfort and ease of use of the device, the acceptability, and cost of nursing staff and patients and select the IPC device according to the wishes of patients and the conditions of the hospital, which is helpful to select the appropriate IPC device. | 1b | B |
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| Timing | (16) For patients who have undergone skull, head and neck, spine, chest, and abdominal surgery, spinal cord injury, and severe trauma, intermittent inflating compression device shall be provided for 30 days or until the patient reaches his/her normal activity or discharge. | 2b | A |
| (17) Surgical patients usually begin IPC treatment during or after surgery and may require 10–14 days of thromboprophylaxis after surgery. For patients undergoing major orthopedic surgery, further extending the preventive measures to 35 days after surgery can further reduce the occurrence of DVT. | 2b | A |
| (18) For patients with moderate or higher risk of VTE during operation, IPC mechanical prevention is preferred, and it is recommended to start using before anesthesia until the patient can move normally or leave hospital. | 5a | B |
| (19) The IPC is recommended to ensure that the daily use time is at least 18 hours in the daytime and at night. For patients who are completely unable to move, the daily use time should be extended as much as possible under the premise of patient tolerance. | 3d | B |
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| Method | (20) Due to the different types, specifications, and manufacturers of IPC, there are also differences in the frequency, compression method, and compression strength of IPC. Please refer to the product manual for use. | 5b | B |
| (21) The patient needs to stay in bed during use, and the wrap of the cuff should start from the far end of the limb and gradually wind up. | 5b | B |
| (22) It is recommended to use IPC with lower limb sequential compression for VTE prevention in trauma patients. | 3c | B |
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| Security management | (23) During the treatment, the nurse observed the operation of the pressure pump, the power supply, the condition of the pipe and leg cover, and the machine alarm and kept communicating with the patient to understand their comfort and tolerance, to ensure the safety of the patient. | 1b | A |
| (24) In case of suspicious VTE signs during treatment, timely assessment and appropriate diagnostic evaluation shall be conducted to eliminate such potential fatal complications. | 1b | A |
| (25) Stop using IPC in the following cases: (1) the patient was suspected or confirmed to have DVT; (2) the patient was suspected or confirmed to have pulmonary embolism; (3) the patient has diagnosised pressure injury or severe lower limb circulation disorder; (4) the patient starts palliative treatment; (5) the patient’s free movement; and (6) the patient has been discharged. | 1c | B |
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| Training and patient education |
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| Medical staff training | (26) It is suggested that medical staff should be fully trained to strengthen their VTE awareness, prevention awareness, and standardized management ability, to achieve timely assessment and treatment to prevent the occurrence of VTE. | 5b | B |
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| Health education for patients and their families | (27) We strongly encourage medical staff to carry out early mobilization for high-risk patients and provide adequate health education on VTE risks, signs, symptoms, and preventive measures for patients and their families, to reduce the possibility of thrombosis. | 5b | B |
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