The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [606]
The higher the number of risk factors, the greater the risk for VTE (NICE 2010, C; SIGN, 2002, C).
2 Assess and record in the patient’s documentation the patient’s suitability for antiembolic stockings, identifying whether the patient has any contraindications to wearing antiembolic stockings (see Box 14.3). To comply with national guidelines and hospital policy/guidelines.
To ensure that antiembolic stockings are fitted correctly and to reduce the complications associated with antiembolic stockings (All Wales Tissue Viability Nurse Forum 2009, C; HoCHC 2005, C; NICE 2010, C; Rashid et al. 2005, E; SIGN 2002, C).
3 Explain and discuss the procedure with the patient and provide written information as follows:
(a) reasons for wearing antiembolic stockings
(b) how to fit and wear stockings
(c) what to report to the nurse, for example any feelings of pain or numbness or skin problems
(d) skin care, that is, wash and dry legs daily
(e) reasons for early mobilization and adequate hydration
(f) reasons for not crossing legs or ankles
(g) length of time that the stockings should be worn, for example until the patient returns to their usual level of mobility.
To ensure that the patient understands the procedure and gives their valid consent (NMC 2009, C; NMC 2008, C).
To ensure that the patient understands how to fit and wear stockings including self-care measures and what to report to the nurse so as to detect complications early, for example pressure sores, circulation difficulties of wearing antiembolic stockings (NICE 2010, C; SIGN 2002, C).
Procedure
4 Perform hand hygiene and put on apron prior to the procedure. To prevent cross-infection (Pratt et al. 2007).
5 Place the tape measure around the calf at the greatest point and measure the calf circumference (and leg measurements) according to the manufacturer’s instructions, recording the measurements in the patient’s documentation. To comply with the manufacturer’s instructions. C
Incorrect sizing causes swelling and bruising to ankles and can constrict blood supply, leading to long-term complications. C
6 Check pedal pulses are intact. To ensure the patient has good circulation to the feet and antiembolic stockings are not contraindicated (NICE 2010, C; SIGN 2002, C).
7 Apply the antiembolic stocking to the legs according to the manufacturer’s instructions. To ensure correct size of stocking is fitted correctly. C
Postprocedure
8 Remove stockings daily, observing for pain, skin damage, circulation difficulties which may arise as a result of wrinkling, and so on, of stocking, but for no more than 30 minutes: confirm size is applicable (SIGN 2002). To review calf and/or leg measurements to ensure stockings fit correctly (NICE 2005, C; SIGN 2002, C).
Reported complications of wearing antiembolic stockings include pressure sores (NICE 2005, C) and circulation difficulties, for example arterial occlusion, thrombosis, gangrene (SIGN 2002, C). The circulation complications can be linked to the tourniquet effect of bunched-up stockings combined with swelling of the leg (HoCHC 2005, C; SIGN 2002, C).
9 Where worn, ensure that antiembolic stockings are of the correct size and fit smoothly. Check the colour and tips of the toes. Note: top band of stockings must not be turned down. To prevent a tourniquet effect if the stocking rolls down. C
To ensure the blood supply is not compromised. C
10 Encourage early mobilization. For patients on bed rest, encourage deep breathing and exercises of the leg hourly, flexion/extension and rotation of the ankles. To improve venous circulation (NICE 2010, C; SIGN 2002, C).
11 Encourage patient to sit with legs up when resting. It is recognized that this will reduce limb swelling and promote venous return by its gravitational effect; however, there is little scientific data to clarify that this does reduce the risk of VTE. Note: care should be taken with patients with ischaemic legs (NICE 2007, C).
12 Monitor for signs of DVT or PE and report to medical staff immediately (see