When should anti embolic hose be applied?

Anti-embolism stockings are used for patients who are recovering from surgery or who are non-ambulatory for any reason.  The stockings encourage normal function of the venous and lymphatic systems of the leg and prevent complications related to pooling blood from arising.  Before you apply a stocking, begin by gathering your supplies and washing your hands.  Then, follow these steps for proper and safe application of the elastic stocking:

1. Greet your patient, and explain what you are going to do.  This gives the patient an opportunity to assist you with the procedure, and reduces anxiety around medical procedures.
2. Check the size of the stockings to ensure they are the correct size for your patient.  You will also want to ensure the patient does not have a latex allergy, as elastic may contain latex.
3. Assist the patient in lying down on his or her back, also known as the supine position.
4. Make sure the patients feet are dry. You can apply talcum powder if they are not dry.
5. Gather the fabric of the stocking into your hand, and place it onto the patient’s foot.
6. Continue to roll the stocking upwards until the upper edge of the stocking reaches just above the patient’s knee.
7. Examine the stocking to ensure there are no wrinkles in the fabric, as this may be uncomfortable for the patient.  Check the fit at the toes and heel, to verify correct placement of the foot.
8. Assist the patient into a comfortable position if he or she wishes to move.  Remove your gloves and dispose of them safely.  Repeat the hand washing procedure to avoid the spread of disease.

While your patient is wearing the elastic stockings, you will need to regularly monitor them to ensure that all extremities are receiving adequate circulation.  Check the patient’s toes for signs of decreased circulation such as coldness, slow refill, or discomfort. If the patient complains of numbness, tingling, or loss of feeling in any extremity, report it to the nurse immediately.   Remove stockings every eight hours to allow for adequate circulation.  Removal of the stockings should be done by the doctor’s order.  Proper application of anti-embolism stockings is an important part of patient care, and can prevent life-threatening complications from occurring.

Expert Tip:

Putting on anti-embolism stockings can be a nerve wracking experience, especially for new CNA’s! Some people have a “thing” about feet and this makes it difficult to properly work with the stockings. Others are afraid of putting too much pressure or pulling on the patients legs too hard when putting on or taking the hose off. These are common fears; and you would be right in thinking that you have to use gentle force when doing this skill. They can be very difficult to get onto your patient if you are fearful of jumping in there and actually exerting any force to get the job done! If you are having trouble mastering this skill, don’t feel bad. Even I have issues with it after 12 years. In fact, putting any type of socks on even my children is hard for me because it is simply awkward!

To ease your troubled mind and help you do well on your skills test, go to Wal-mart and buy yourself a pair of TED hose. Begin by putting them on your own feet and legs, then move onto other people’s feet and legs! Grab onto your spouse, your kids, your parents and your friends – anyone who will allow you to play with their tootsies! The more you do it, the more comfortable you will be with it. Work on whatever your main issues are. For many of us it is getting the hose on without leaving wrinkles behind. Trust me when I say that this is something we have all struggled with and overcome. You will overcome it too- just practice! Also remember that they instructor giving the skills test is not against you. If you make a mistake or two, simply stop, tell what your mistake was and continue on from that point. Take a deep breath and pretend you are alone.

1. Agu O, Hamilton G, Baker D. The burden of venous thromboembolism in Australia. The Australia and New Zealand Working Party on the Management and Prevention of Venous Thromboembolism 2008; [cited 15th March 2010]; Available from: http://www.accesseconomics.com.au/reports/209.pdf.

2. Cock KA. Anti‐embolism stockings: are they used effectively and correctly? Br J Nurs 2006;15: S4–12. [PubMed] [Google Scholar]

3. Nicolaides AN, Breddin HK, Fareed J. Prevention of venous thromboembolism. International Consensus Statement. Guidelines compiled in accordance with the scientific evidence. Int Angiol 2001;20:1–37. [PubMed] [Google Scholar]

4. NICE. Venous thromboembolism: reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients undergoing surgery . Clinical guideline No 46. National Institute for Health and Clinical Excellence 2007. [cited; Available from: http://www.nice.org.uk/nicemedia/pdf/VTEFullGuide.pdf.

5. Fletcher J, Baker R, Fisher C, Gallus A, Matthews G, Stacey M, MacLellan DG, Flanagan D, Chong B, Gibbs H, Salem H, Van Rij A, Gatt S, Hannan T. Australia & New Zealand Working Party on the Management and Prevention of Venous Thromboembolism. Prevention of Venous Thromboembolism: Best Practice Guidelines for Australia & New Zealand. 2005. [cited 4th February, 2010]; Available from: http://www.safetyandquality.health.wa.gov.au/docs/squire/14.%20ANZ%20Prevention%20of%20VTE%20Ed3%202005.pdf.

6. Schluter J, Scotter H, Chaboyer W, Australia & New Zealand Working Party on the Management and Prevention of Venous Thromboembolism. Prevention of Venous Thromboembolism: Best Practice Guidelines for Australia & New Zealand. 2007.

7. Schluter J, Scotter H, Chaboyer W. Best practice guidelines for Australia and New Zealand on the prevention of venous thromboembolism: issues and implications for nurses. Contemp Nurse 2008;29:3–7. [PubMed] [Google Scholar]

8. ICS Prevention of venous thrombolembolism – guidelines according to scientific evidence (International Consensus Statement). Int Angiol 1997; 16: 3–38. [PubMed] [Google Scholar]

9. Cook D, Attia J, Weaver B, McDonald E, Meade M, Crowther M. Venous thromboembolic disease: an observational study in medical‐surgical intensive care unit patients. J Crit Care 2000;15:127–32. [PubMed] [Google Scholar]

10. Agu O, Hamilton G, Baker D. Graduated compression stockings in the prevention of venous thromboembolism. Br J Surg 1999;86:992–1004. [PubMed] [Google Scholar]

11. Geraghty S, Russell J, Gilbourne S, Young J. Deep vein thrombosis – aetiology and prevention. Nurs Times 2001;97:34–5. [PubMed] [Google Scholar]

12. Razavi M. Interventional management of deep vein thrombosis in Peripheral Vascular Interventions (Kandarpa, K). Philadelphia: Lippincottt Williams & Wilkins, 2008: p. Ch 22:p377. [Google Scholar]

13. MacLellan D. Compression profiles of antiembolic stockings. Aust NZ J Phlebol 2002; 6:9–14. [Google Scholar]

14. Gaylarde P, Sarkany I, Dodd H. The effect of compression on venous stasis. Br J Surg 1993;128: 255–8. [PubMed] [Google Scholar]

15. Robertson‐Malt S, Holly C, Salmond S, Thongchai C, Peanmongkol Y, Davis P, Parnham A, Kent, B. Graduated compression stockings for the prevention of post‐operative venous thromboembolism (Evidence based information sheets for health professionals). Best Pract 2008;12:1–4. [Google Scholar]

16. Autar R. A review of the evidence for the efficacy of anti‐embolism stockings in venous thromboembolism prevention. J Orthop Nurs 2009;13:41–9. [Google Scholar]

17. Merrett N, Hanel K. Ischaemic complications of graduated compression stockings in the treatment of deep vein thrombosis. Postgrad Med J 1993;69:232–4. [PMC free article] [PubMed] [Google Scholar]

18. Lawrence D, Kakkar V. Graduated, static, external compression of the lower limb: a physiological assessment. Br J Surg 1980;67:119–21. [PubMed] [Google Scholar]

19. Hameed M, Browse DJ, Immelman EJ, Goldberg PA. Should knee‐length replace thigh‐length graduated compression stockings in the prevention of deep vein thrombosis? S Afr J Surg 2002;40:15–6. [PubMed] [Google Scholar]

20. Williams J, Davies PR, Sweetnam DI, Harper G, Pusey R, Lightowler CD. Knee‐length versus thigh‐length graduated compression stockings in the prevention of deep vein thrombosis. Br J Surg 1996;83:1553. [PubMed] [Google Scholar]

21. Sparrow R, Hardy J, Fenton P. Effect of antiembolism compression hosiery on leg blood volume. Br J Surg 1995;82:53–9. [PubMed] [Google Scholar]

22. Wildin C, Hui ACW, Esler CAN, Gregg PJ. In vivo pressure profiles of thigh‐length graduated compression stockings. Br J Surg 1998;85:1228–31. [PubMed] [Google Scholar]

23. Byrne B. Deep vein thrombosis prophylaxis: the effectiveness and implications of using below‐knee or thigh‐length graduated compression stockings. J Vasc Nurs 2002;20:53–9. [PubMed] [Google Scholar]

24. Byrne B. Deep vein prophylaxis: the effectiveness and implications of using below knee or thigh‐length graduated compression stockings. Heart Lung 2001;30:277–83. [PubMed] [Google Scholar]

25. Winslow EH, Brosz DL. Graduated compression stockings in hospitalized postoperative patients: correctness of usage and size. Am J Nurs 2008;108:40–50. quiz 50–1. [PubMed] [Google Scholar]

26. NHMRC. Clinical practice guideline for the prevention of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to Australian hospitals . Melbourne: National Health and Medical Research Council. 2009 [cited 19th January, 2010]; Available from: http://www.nhmrc.gov.au/_files_nhmrc/file/nics/programs/vtp/draft_guideline_on_prevention_of_vte_for_public_consultation.pdf.

27. Parnaby G. A new anti‐embolism stocking. Br J Perioper Nurs 2004;14:302–7. [PubMed] [Google Scholar]

28. McConnell E. Applying antiembolism stockings. Nursing 2002;32:17. [PubMed] [Google Scholar]

29. Kay T, Martin F. Heel ulcers in patients with long‐standing diabetes who wear antiembolic stockings. Med J Aust 1986;145:290–1. [PubMed] [Google Scholar]

30. Amarigiri S, Lees T. Elastic compression stockings for prevention of deep vein thrombosis. Cochrane Database Syst Rev 2000;3:(CD001484 latest version 8 Nov 1999). [PubMed] [Google Scholar]

31. Walker L, Lamont S. The use of antiembolic stockings. Part 1: a literature review. Br J Nurs 2007;16: 1408–12. [PubMed] [Google Scholar]

32. Scholten P, Bever A, Turner K, Warburton L. Graduated elastic compression stockings on a stroke unit: a feasibility study. Age Ageing 2000;29:357–9. [PubMed] [Google Scholar]

33. Bujas L. Personal communication, August 4th. 2009.

34. Austin Health. Venous Thromboembolism Prevention 2007 [cited 25 May 2010]; Available from: http://armcnet/departments/clin%5Fgov/clinical%20governance%20intranet/venous%20thromboembolism%20prevention.htmnogo.

35. EPUAP. Guide to Pressure Ulcer Grading. 2009 [cited 31 July 2009]; Available from: http://www.epuap.org/grading.html.

36. WHO. Guidelines for Medical Record and Clinical Documentation WHO‐SEARO Coding Workshop. 2007 [cited 20 May 2010]; Available from: http://www.searo.who.int/LinkFiles/2007_Guidelines_for_Clinical_Doc.pdf.