Essential Information You Should Know About Sequential Compression Devices (SCDs)

As a Certified Nursing Assistant (CNA), it is essential to have a comprehensive understanding of medical devices that assist in patient care. One such device is the Sequential Compression Device (SCD), which plays a significant role in the prevention of Deep Vein Thrombosis (DVT). The use of these devices is often a critical aspect of patient care, especially for those who are immobile or at risk of developing blood clots. In this section, we will delve into the functioning of SCDs, their importance in patient care, and the role CNAs play in their application and management.

What Are Sequential Compression Devices (SCDs)?

Sequential Compression Devices are medical tools used to help reduce the risk of blood clots in patients who are immobile or have restricted mobility. SCDs are designed to mimic the natural motion of muscle contractions in the legs, promoting circulation and venous return, which helps prevent blood stasis and clot formation. These devices are commonly used for bedridden patients, recovering from surgery, or experiencing long periods of immobility due to illness or injury.

The primary function of an SCD is to reduce the risk of deep-vein thrombosis (DVT). DVT is a serious condition where blood clots form in the deep veins of the legs. If left untreated, these clots can travel to the lungs, causing a Pulmonary Embolism (PE), a life-threatening condition. SCDs help prevent DVT by using controlled pneumatic compression, which encourages blood circulation and prevents blood from pooling in the lower extremities.

Understanding the Risk of DVT

Deep Vein Thrombosis (DVT) is a significant concern in healthcare, particularly for patients who are immobile. When a person remains still for an extended period, the natural flow of blood in the veins of the legs slows down. This stagnation can lead to the formation of blood clots. The longer a patient remains immobile, the greater the risk of developing DVT.

Prolonged immobility can result from various factors, including post-operative recovery, severe illness, or injury. Patients who are unable to move their legs due to pain or weakness are particularly vulnerable. Without adequate circulation, the blood in the veins of the legs becomes sluggish, and the risk of clot formation increases. In such cases, Sequential Compression Devices are used to prevent these complications by providing consistent pressure that simulates the action of muscle contractions, encouraging blood to move back towards the heart.

The Role of CNAs in the Use of SCDs

Certified Nursing Assistants (CNAs) are often responsible for the application, monitoring, and maintenance of medical devices like SCDs. As a CNA, you play a crucial role in ensuring that these devices are correctly applied and functioning properly to maximize their effectiveness in preventing DVT. Understanding how SCDs work, the correct application methods, and potential complications that can arise is vital to providing high-quality patient care.

While CNAs are not typically responsible for programming or adjusting the settings on the SCD machines themselves, you will be involved in tasks such as preparing the patient for device use, ensuring proper sizing, and monitoring for any signs of discomfort or malfunction. Additionally, it is crucial to be aware of any contraindications for the use of SCDs, as some medical conditions may make their use unsafe.

By thoroughly understanding how Sequential Compression Devices work and how to use them effectively, CNAs can help prevent the development of DVT in at-risk patients. This, in turn, reduces the risk of serious complications, improves patient comfort, and supports the overall recovery process.

How SCDs Work: The Mechanics Behind the Device

The main purpose of Sequential Compression Devices is to mimic the natural pumping action of the muscles in the legs during activities like walking. When a person walks, the muscles in the legs contract and relax, which helps propel blood through the veins and back to the heart. This rhythmic contraction and relaxation push blood upwards and prevent it from pooling in the lower extremities.

SCDs operate on a similar principle. They consist of inflatable cuffs that are placed around the patient’s legs, typically from the ankle to just below the knee or up to the thigh. These cuffs are divided into multiple chambers, which inflate and deflate in a specific sequence. As the cuffs inflate, they apply pressure to the veins in the leg, pushing the blood upwards toward the heart. Once the cuff deflates, the pressure is released, and the veins refill with blood. This cycle repeats itself at regular intervals, simulating the muscle contractions that occur during walking.

The inflation and deflation cycle of the cuffs is controlled by a machine that regulates the pressure applied. The device uses pneumatic compression, which is generated by air pressure, to apply the necessary force. The goal is to promote venous return, reduce blood stasis, and prevent clot formation in the veins of the legs.

Pneumatic Compression: The Key Mechanism

The driving force behind the operation of an SCD is pneumatic compression. Pneumatic compression involves the use of air pressure to create a mechanical force that mimics the natural muscle contractions in the legs. The cuffs of the SCD are connected to a control unit that inflates and deflates them in a specific pattern. The air pressure applied to the cuffs pushes the blood in the veins upwards toward the heart, promoting circulation and preventing blood from pooling in the legs.

The device works sequentially, meaning that the chambers of the cuff inflate and deflate in a specific order. The lower chambers of the cuff inflate first, followed by the upper chambers. This sequential compression helps simulate the natural flow of blood through the veins, similar to the effect of muscle contractions. By continuously promoting blood flow, SCDs help prevent blood clots from forming in the veins.

Importance of SCDs in Patient Care

For patients who are immobile or sedentary, the use of Sequential Compression Devices can significantly reduce the risk of developing Deep Vein Thrombosis (DVT). Patients recovering from surgery, particularly those who have undergone major procedures like hip or knee replacement, are often at high risk for DVT. Without adequate circulation, blood can pool in the legs, increasing the risk of clot formation. SCDs help prevent this by mechanically stimulating circulation and improving venous return.

In addition to preventing DVT, SCDs can also improve patient comfort. Prolonged immobility often leads to leg swelling and discomfort, particularly in patients who are bedridden or have limited mobility. By promoting circulation and preventing blood stagnation, SCDs help alleviate swelling and improve overall comfort during the recovery process.

The Functionality and Benefits of Sequential Compression Devices (SCDs)

Sequential Compression Devices (SCDs) play a pivotal role in preventing serious medical conditions such as Deep Vein Thrombosis (DVT) and enhancing patient comfort during recovery. In this section, we will further explore how these devices function, their benefits to patient care, and their application in clinical settings.

How SCDs Work in Preventing DVT

The core function of Sequential Compression Devices is to prevent the development of DVT, a condition characterized by the formation of blood clots in the deep veins, typically in the legs. The risk of DVT is particularly elevated in patients who are unable to move or are confined to bed rest for extended periods. As mentioned earlier, blood flow slows when a person remains immobile, leading to a higher likelihood of clot formation. This is where SCDs become invaluable.

SCDs utilize a set of inflatable cuffs that wrap around the patient’s legs. These cuffs are divided into multiple chambers that inflate and deflate in a specific sequence. This process, known as pneumatic compression, mimics the natural muscle contractions that occur when a person walks. When the cuff inflates, it exerts pressure on the veins in the legs, effectively pushing blood towards the heart. As the cuff deflates, it allows the veins to refill with blood, repeating the cycle continuously. This action promotes venous return, improving circulation and reducing the risk of blood pooling in the lower extremities.

By simulating the natural movement of the legs, SCDs improve blood circulation, which helps to prevent stasis and the formation of clots. Additionally, the regular inflation and deflation of the cuffs help maintain optimal blood flow, supporting the overall health of the vascular system and reducing the chances of complications such as Pulmonary Embolism (PE), which can occur when a blood clot breaks loose and travels to the lungs.

The Benefits of SCDs in Patient Care

Sequential Compression Devices offer numerous benefits to patients, particularly those who are at high risk for developing DVT due to immobility. The benefits of SCDs extend beyond clot prevention, enhancing both patient safety and comfort. Here are some of the key advantages:

1. Prevention of DVT and Pulmonary Embolism (PE)

The most significant benefit of SCDs is their role in preventing DVT. By improving blood circulation in the legs, SCDs reduce the risk of blood clots forming in the veins. These clots can lead to severe complications, such as Pulmonary Embolism, when they dislodge and travel to the lungs, blocking blood flow and causing respiratory distress. Regular use of SCDs can significantly lower the incidence of these life-threatening conditions, promoting better overall patient outcomes.

2. Reducing Swelling and Discomfort

Patients who are immobile for long periods often experience leg swelling and discomfort due to poor circulation. The rhythmic inflation and deflation of SCD cuffs stimulate circulation, helping to reduce swelling in the legs. By promoting venous return, SCDs also alleviate the feelings of heaviness or tightness that often accompany prolonged immobility. This improved circulation contributes to a higher level of comfort for patients, which can enhance their recovery experience.

3. Enhancing Post-Surgical Recovery

Patients recovering from surgery, particularly orthopedic surgeries like hip or knee replacement, are at a heightened risk for developing DVT. During recovery, many patients are required to remain in bed or limit their movement. SCDs provide an essential tool in this context, helping to prevent blood clots from forming while promoting recovery by improving circulation. This reduces the need for more invasive interventions such as blood thinners or additional treatments, contributing to a faster and more comfortable recovery process.

4. Non-invasive and Easy to Use

Unlike medications or surgical interventions, Sequential Compression Devices are non-invasive and relatively simple to use. The application process is straightforward, and once the device is properly set up, it requires minimal intervention. This makes SCDs a safe, effective, and easy-to-implement solution for preventing DVT and improving circulation. As a CNA, your role in ensuring proper placement and functionality of the device is critical to achieving the desired outcomes.

5. Supporting Long-Term Mobility and Health

For patients who are chronically ill or those who experience extended periods of immobility, the use of SCDs can help maintain circulation over the long term. These patients are at an increased risk of developing complications such as blood clots, varicose veins, and venous insufficiency. Regular use of SCDs can help reduce the risk of these complications, supporting the long-term health of the patient’s vascular system and improving overall quality of life.

The Role of CNAs in SCD Application and Management

As a CNA, you play an essential role in the effective use of Sequential Compression Devices. Understanding how to apply and manage these devices correctly is vital to ensuring patient safety and comfort. While nurses and other healthcare providers typically oversee the initial prescription and monitoring of SCD use, CNAs are often the ones who apply the devices, check for proper function, and ensure patient comfort. Here are the key responsibilities CNAs should be aware of when using SCDs:

1. Patient Assessment and Sizing

Before applying an SCD, it is essential to assess the patient’s leg measurements to ensure the cuffs are the correct size. If the cuffs are too tight, they may cause discomfort or restrict blood flow, while cuffs that are too loose may not provide sufficient compression to prevent DVT. Proper sizing is crucial for the effectiveness of the device, so it is important to carefully measure the patient’s legs and select the appropriate cuffs.

2. Application of SCDs

Once the correct size has been selected, the next step is to apply the cuffs properly. The cuffs should be placed on the patient’s legs, typically from the ankle to just below the knee or up to the thigh, depending on the healthcare provider’s instructions. The cuffs must lie flat against the skin without any wrinkles or folds, as these can cause uneven pressure and lead to discomfort or skin damage.

3. Monitoring and Maintenance

After the SCDs are applied and the machine is activated, it is important to monitor the device’s functionality. Check that the cuffs are inflating and deflating in the correct sequence and that the patient is not experiencing any discomfort. Additionally, it is important to periodically inspect the skin underneath the cuffs for any signs of irritation, redness, or pressure sores. If any issues arise, it is essential to notify the healthcare provider promptly.

4. Education and Communication with the Patient

Patients may have questions or concerns about the SCDs, and it is important to provide clear, concise information. Explain how the device works, the benefits it offers, and what the patient can expect during its use. Encourage the patient to report any discomfort or unusual sensations they may experience, and reassure them that their well-being is a top priority. Open communication between you, the patient, and the rest of the healthcare team is essential for ensuring the best possible outcomes.

Proper Care and Application of Sequential Compression Devices (SCDs)

The effective use of Sequential Compression Devices (SCDs) requires a clear understanding of proper application, sizing, and monitoring to ensure patient safety and comfort. As a Certified Nursing Assistant (CNA), your role is vital in the day-to-day management of these devices. This section will focus on the proper steps for applying and managing SCDs, common issues to look out for, and how to ensure the device continues to function as intended.

Choosing the Right SCD Cuff Size

The proper fit of an SCD cuff is crucial for both the effectiveness of the device and the comfort of the patient. SCD cuffs come in various sizes, so it is important to select the right one based on the patient’s leg measurements. Incorrect sizing can cause a variety of issues, including discomfort, ineffective compression, and even skin damage.

Before applying the SCD cuff, take measurements of the patient’s leg, typically from the ankle to just below the knee, or up to the thigh if the protocol requires. Ensure that the cuffs wrap fully around the leg, providing a snug fit without cutting off circulation or causing any constriction. If the cuffs are too tight, they may cause discomfort, skin irritation, or impede blood flow. On the other hand, if the cuffs are too loose, they may not generate enough pressure to effectively prevent DVT.

Once the correct size has been selected, ensure that the cuffs are properly positioned on the leg to maximize their effectiveness. The cuffs must be adjusted so that they cover the full area prescribed by the healthcare provider. The cuffs should also be placed symmetrically on both legs to ensure even compression.

Proper Placement of SCD Cuffs

The placement of SCD cuffs on the patient’s legs is critical for ensuring proper function and preventing discomfort. When positioning the cuffs, ensure that they lie flat against the skin, without any wrinkles or folds. Wrinkles or folds can cause uneven pressure distribution, leading to discomfort or even pressure sores. Proper placement allows the cuffs to inflate and deflate as intended, maximizing the benefits of the device.

The typical placement of SCD cuffs is from the ankle to just below the knee. However, depending on the specific protocol, the cuffs may need to extend up to the thigh. Regardless of the cuff length, it is important to ensure that the cuffs are positioned securely and that they are not too tight or too loose around the legs. Also, make sure that the cuffs are placed in a way that avoids any contact with bony prominences or other sensitive areas of the legs, which may cause discomfort.

After positioning the cuffs, check that the tubing connecting the cuffs to the control unit is not kinked or obstructed. Kinks or obstructions can impede the flow of air to the cuffs, affecting their inflation and deflation cycle. Once the cuffs are positioned correctly and the tubing is properly connected, the SCD unit can be activated.

Setting Up the SCD Device

After ensuring the cuffs are properly placed, the next step is to set up the SCD device. The device is typically connected to the cuffs through tubing, which channels air into the cuffs to inflate and deflate them in a specific sequence. The SCD device has a control unit that regulates the inflation and deflation of the cuffs.

It is important to follow the healthcare provider’s instructions for setting the pressure and cycle times on the device. These settings will vary depending on the patient’s condition and the protocol for the treatment. The pressure settings should be high enough to provide effective compression but not so high that they cause discomfort or impede circulation. Cycle times will determine how frequently the cuffs inflate and deflate, and this cycle should mirror the natural muscle contractions in the legs.

Once the settings have been configured, double-check that the device is functioning correctly. The cuffs should inflate sequentially, starting from the lower chambers and moving upwards. This action simulates the muscle contractions that occur during walking, helping to push blood back towards the heart. Regularly monitor the device to ensure it is cycling properly and delivering consistent pressure.

Regular Monitoring of SCD Functionality

After setting up the SCD device and ensuring that the cuffs are properly positioned, the next responsibility is to regularly monitor the device to ensure its continued effectiveness. As a CNA, you will need to keep an eye on the device throughout its use, checking for both function and patient comfort.

1. Checking for Proper Inflation and Deflation

Regularly observe the inflation and deflation cycles of the cuffs. The device should inflate the lower chambers first, followed by the upper chambers, and then deflate in reverse order. This sequence is important for mimicking the natural flow of blood through the veins and promoting effective venous return.

If you notice that the device is not inflating or deflating as intended, check the tubing for any blockages or kinks. If the device is malfunctioning, notify the healthcare provider immediately so that adjustments can be made.

2. Monitoring Patient Comfort

Patient comfort is a key concern when using SCDs. While these devices are designed to reduce the risk of DVT and improve circulation, they can sometimes cause discomfort if not applied or monitored properly. As you monitor the patient, ask them if they feel any discomfort or pain while the device is in use. If the patient experiences any pain, excessive pressure, or discomfort, adjust the device accordingly and inform the healthcare provider.

It is also important to check for any signs of skin irritation or damage under the cuffs. Look for redness, swelling, or pressure sores, which can result from the constant pressure applied by the cuffs. If any skin abnormalities are detected, immediately notify the healthcare provider, as adjustments to the device or treatment plan may be required.

3. Ensuring Proper Device Operation

The SCD device should be operating continuously, cycling through the inflation and deflation phases at regular intervals. You should also ensure that the device is properly powered and that there are no issues with the control unit or electrical connections. If you notice any malfunction, check the power source and connection points to ensure everything is functioning as intended.

Inspecting the Skin Under the SCD Cuffs

Skin inspection is an essential part of managing SCD therapy. Prolonged use of the cuffs, particularly if they are not properly positioned or if the device is malfunctioning, can lead to skin irritation or even pressure ulcers. Regularly inspect the skin under the cuffs for any signs of redness, swelling, or discomfort. If you notice any changes in the skin condition, inform the healthcare provider immediately.

Additionally, check the areas where the cuffs make contact with the skin, particularly over bony prominences such as the knees, ankles, and lower thighs. These areas are more prone to developing pressure sores due to the consistent pressure exerted by the cuffs. Ensure that the cuffs are not too tight or positioned in a way that causes excessive pressure on these sensitive areas.

Troubleshooting Common SCD Issues

While SCDs are generally reliable devices, there may be instances when issues arise. Some of the most common problems include:

1. Air Leaks

Air leaks in the cuffs or tubing can reduce the effectiveness of the device. If you notice that the cuffs are not inflating properly or that the pressure is inconsistent, check the tubing and cuffs for any visible signs of damage or leaks. If a leak is found, it may be necessary to replace the damaged part or adjust the tubing connections.

2. Incorrect Inflation

If the cuffs are not inflating in the proper sequence (lower to upper chambers), check the control unit to ensure that the settings are correct. Sometimes, a malfunctioning unit may cause the cuffs to inflate unevenly. If the issue persists, inform the healthcare provider and request a replacement or adjustment to the device.

3. Discomfort or Pain

If the patient experiences discomfort or pain while using the SCD, check the fit of the cuffs. Ensure that they are not too tight or causing any pressure on sensitive areas. If the cuffs appear to be too tight, consider adjusting their positioning or using a different size. Additionally, ensure that the cuffs are lying flat against the skin without any wrinkles or folds.

Contraindications for the Use of Sequential Compression Devices (SCDs)

While Sequential Compression Devices (SCDs) are highly effective in preventing Deep Vein Thrombosis (DVT) and improving circulation, there are certain situations where their use may be contraindicated. Certified Nursing Assistants (CNAs) must be aware of these contraindications to ensure patient safety. In this section, we will explore the conditions and circumstances under which SCDs should not be used and highlight the importance of assessing each patient individually.

Key Contraindications for SCD Use

Sequential Compression Devices are generally safe and effective, but their use can be harmful under certain medical conditions. As a CNA, it is essential to recognize when it is not appropriate to use SCDs and ensure that the device is not applied in these situations without consulting a healthcare provider. Below are some of the primary contraindications for the use of SCDs.

1. Severe Leg Dermatitis or Skin Irritation

Patients with severe leg dermatitis or skin inflammation should not use SCDs. The pressure exerted by the cuffs could exacerbate skin irritation, causing further discomfort and potential injury. Dermatitis is a condition where the skin becomes inflamed, red, and irritated, and in severe cases, the skin may even crack or break open. The application of the inflatable cuffs could worsen this irritation, leading to an increased risk of skin breakdown.

In cases of leg dermatitis, alternative methods of DVT prevention should be considered, such as pharmacological interventions or mechanical methods that do not involve direct pressure on the skin. CNAs should closely monitor any changes in the patient’s skin condition and report any concerns to the healthcare provider.

2. Recent Skin Graft or Wound Healing

Patients who have recently undergone a skin graft or have open wounds on their legs should not use SCDs until their skin has fully healed. The pressure applied by the cuffs could interfere with the healing process, potentially causing damage to the graft or opening up the wound. This can lead to delayed healing, increased risk of infection, and other complications.

In cases of skin grafts or wounds, healthcare providers may recommend other methods to prevent DVT, such as anticoagulant therapy or other supportive devices that do not exert pressure on the healing tissue. CNAs should always check with the healthcare provider before using an SCD in these cases to ensure that it is safe.

3. Peripheral Artery Disease (PAD)

Peripheral Artery Disease (PAD) is a condition in which the blood vessels in the legs become narrowed or blocked, reducing blood flow to the extremities. In patients with PAD, applying pressure through SCD cuffs can worsen the condition by further limiting blood flow to the affected areas. This could result in increased pain, discomfort, and potential injury to the leg.

For patients with PAD, healthcare providers may recommend alternative methods of DVT prevention that do not involve compression. CNAS must assess the patient’s medical history and be aware of any conditions, such as PA, D, before applying an SCD.

4. Venous Thrombosis or Known Deep Vein Thrombosis (DVT)

The use of SCDs in patients who already have a diagnosed or suspected deep vein thrombosis (DVT) is contraindicated, as the mechanical pressure exerted by the cuffs can cause a blood clot to dislodge. This can lead to a pulmonary embolism (PE), a life-threatening condition where a clot travels to the lungs, blocking blood flow and causing respiratory failure.

If there is a known or suspected DVT, the priority is to manage the clot with appropriate medical treatments, such as anticoagulation therapy, rather than using mechanical devices like SCDs. CNAs should never apply SCDs to patients with confirmed or suspected DVT without explicit instruction from a healthcare provider.

5. Recent Leg Fractures or Significant Trauma

Patients who have sustained recent leg fractures or significant trauma to the legs should not use SCDs. The pressure applied by the cuffs could displace bone fragments or exacerbate existing injuries. Additionally, the trauma could lead to increased swelling, and applying pressure could worsen the situation.

In cases of leg fractures or trauma, the healthcare provider may prescribe other methods of DVT prevention, such as medication or mechanical devices that do not exert pressure on the injured area. As a CNA, you must carefully assess the patient’s condition and seek guidance from the healthcare provider before applying an SCD to a patient with recent leg injuries.

6. Congestive Heart Failure (CHF) or Severe Heart Conditions

Patients with congestive heart failure or other severe heart conditions may not be able to tolerate the increased venous return promoted by the SCDs. The additional blood flow may put an unnecessary strain on the heart, which could worsen the patient’s condition. In such cases, SCDs could potentially increase the volume of blood returning to the heart, which can be harmful for individuals with compromised cardiac function.

For patients with heart conditions, the healthcare provider may recommend other methods of preventing DVT, such as anticoagulant therapy or mechanical devices that do not promote excessive venous return. CNAs should always consult with the healthcare team before applying an SCD to patients with heart disease or compromised heart function.

7. Lymphatic Obstruction or Lymphedema

Patients with lymphatic obstruction or lymphedema, a condition where the lymphatic system is impaired, should also avoid the use of SCDs. Applying compression to the legs in these cases may worsen lymphatic drainage, leading to increased swelling and discomfort. The pressure from the cuffs could also exacerbate the underlying condition, potentially leading to further complications.

Lymphedema requires careful management and often involves compression garments specifically designed to manage lymph fluid buildup. For patients with this condition, SCDs should not be used, and other methods of DVT prevention should be explored in consultation with the healthcare provider.

8. Active Infection in the Legs or Lower Extremities

Patients with active infections in the legs or lower extremities should not use SCDs, as the pressure applied by the cuffs may worsen the infection. Infections in the skin, bones, or soft tissues require medical management, and applying compression could impede proper healing or spread the infection. SCDs can also cause irritation or breakdown of the skin, which may allow bacteria to enter and exacerbate the infection.

If a patient has an active infection in the lower extremities, the healthcare provider will likely recommend alternative methods of DVT prevention that do not involve compression. CNAs should assess the patient’s condition and report any signs of infection to the healthcare team before using SCDs.

Evaluating the Patient’s Individual Needs

It is essential to recognize that not all patients will have the same response to SCD therapy. Therefore, CNAs must evaluate the individual needs of each patient before using an SCD. This includes taking into account the patient’s medical history, current health conditions, and any contraindications that may affect the safety of using the device. Regular communication with the healthcare provider is key to ensuring that the patient receives the most appropriate and effective care.

1. Consulting with the Healthcare Team

Before applying an SCD, CNAs should consult with the healthcare provider to ensure that there are no contraindications for the device’s use. If any doubts arise regarding the patient’s suitability for SCD therapy, the CNA should err on the side of caution and seek clarification from the nursing or medical team. In cases where SCDs are not appropriate, alternative methods of DVT prevention, such as medication or mechanical methods, should be implemented.

2. Continuous Monitoring and Patient Assessment

Once the SCD is in use, CNAs should continuously monitor the patient for signs of discomfort, irritation, or other adverse effects. Regular skin checks and communication with the patient are essential to ensuring that the device is functioning correctly and that the patient remains comfortable. If any issues arise, the healthcare provider should be notified immediately so that appropriate adjustments or alternative therapies can be implemented.

Conclusion

Sequential Compression Devices are a vital tool in preventing Deep Vein Thrombosis (DVT) and improving circulation in patients at risk. However, there are certain conditions and circumstances under which their use is contraindicated. As a CNA, understanding these contraindications is crucial to providing safe and effective patient care. By being aware of when not to use SCDs and communicating regularly with the healthcare team, you can help ensure the best possible outcomes for your patients.