Introduction
Antiembolism stockings [also known as “thromboembolic- deterrent” (TED) hose] are made of a stretchy, elastic-like fabric that is meant to gently compress the feet and the legs and applied till knee-high or thigh-high. These help in normal function of the venous and lymphatic systems of the leg and prevent complications related to venous stasis. These have a compression level of 8-18 mmHg.
Definition
Antiembolism stockings are externally applied over the lower extremities to improve the peripheral perfusion, by ensuring a graduated pressure pattern of 18 mmHg at the ankle, 14 mmHg at the calf, 8 mmHg at the popliteal area, 10 mmHg at the lower thigh, and 8 mmHg at the upper thigh.
Purposes
- To maintain adequate perfusion of the lower extremity.
- To enhance venous return.
- To prevent deep vein thrombosis.
Indications
- Altered level of consciousness.
- Bedridden patients.
- Postsurgery.
Contraindications
- Severe peripheral vascular disease (PVD).
- Peripheral neuropathy.
- Severe peripheral edema.
- Soft-tissue diseases including dermatitis, cellulitis, or a recent skin graft.
- Major lower limb injuries.
| Articles | Purpose |
| TED stockings | To apply for the patient. |
| Towel/gauze pad | To dry the skin. |
| Wrist watch with seconds | To assess the pulse. |
Procedure
| Nursing Action | Rationale | |
| 1. | Explain the procedure and obtain consent from the patient. | Alleviates anxiety and promotes cooperation. Serves as legal evidence and prevents litigation of the staff. |
| 2. | Ensure the correct size of the stocking and check for latex allergy (elastic will contain latex). | General preparation for the procedure. |
| 3. | Provide privacy and drape the patient. | Prevents embarrassment. |
| 4. | Wash hands. | Reduces the transmission of microorganisms. |
| 5. | Position the patient in a supine posture. Assess the leg for skin breakdown and palpate the peripheral pulses. | To provide comfort and identify any abnormalities. |
| 6. | Ensure that the feet are dry. | To prevent discomfort. |
| 7. | Apply the stocking onto the patient’s foot, starting from the foot, and continue to roll the stocking upwards until the upper edge of the stocking reaches just above the patient’s knee. Repeat the procedure on the other leg. Note: Make sure that the heel pocket is properly positioned on the patient’s heel. | For accurately applying till the specified position. |
| 8. | Ensure that there are no wrinkles in the fabric of the stocking. Check fit at the toes and heel. | To verify correct placement of the foot. |
| 9. | Assist the patient into a comfortable position. | To ensure comfort. |
| 10. | Perform hand hygiene. | To prevent cross-infection. |
| 11. | Monitor the extremities for signs of decreased circulation (coldness, slow refill, or discomfort). | To identify the adequacy of circulation. |
| 12. | Instruct the patient to report immediately if numbness, tingling, or loss of sensations is present in any extremity. | To identify for complications. |
| 13. | Ensure to remove stockings every 8 hours for 30 minutes. Note: Inappropriate size or improper application may cause skin damage and reduce perfusion. | To allow for adequate circulation. |
| 14. | Document the date, time, reason for application of TED stocking, and allergic reaction to elastics such as swelling, redness, and itching. | For continuity of care. |
Special Considerations
- Measure leg circumference to ensure the correct stocking size.
- Assess skin integrity for any bruising, wounds, or fragile skin.
- Ensure wrinkle-free application to prevent pressure injuries.
- Avoid excessive pulling to prevent skin damage.
- Position the heel correctly within the stocking’s heel pocket.
- Remove stockings daily to check for skin irritation or pressure sores.
- Ensure proper hygiene by washing stockings regularly.
- Avoid rolling down stockings, as this can create a tight band restricting circulation.
- Encourage mobility to enhance circulation.
- Advise on signs of complications such as numbness, pain, or discoloration.
- Ensure correct stocking use at home for continued prevention of deep vein thrombosis (DVT).
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
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