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Applying antiembolic stockings and sequential compression devices: Clinical skills notes

Notes

Notes

Cardiovascular

Applying antiembolic stockings and sequential compression devices

Introduction

Αs a nurse, you will be asked to apply antiembolic stockings and sequential compression devices, or SCDs, in clients that are at risk for deep vein thrombosis, or DVT, such as those who are recovering from a major surgery or have heart and circulatory problems. Make sure you know how they work and how to apply them. 

Antiembolic stockings and SCDs

Antiembolic stockings and SCDs can be used to prevent DVT. They both work by exerting pressure on the veins of the lower legs, promoting blood return to the heart instead of pooling in the legs. Thus, they decrease the risk for blood clots.

Antiembolic stockings look similar to conventional stockings, but they are much more elastic. They can extend from the foot to the calf or thigh level. They can provide different levels of pressure, so it's important to make sure the ones prescribed for the client aren't so tight that they cut off blood circulation but also not too loose because they won’t promote blood return to the heart. They also leave an opening over or under the toes which can be used by the health care team to check blood circulation in the lower leg as well as the color and the temperature of the skin. 

Figure 1: Comparison of Antiembolic stockings (left) and Sequential Compression Devices (SCDs) (right).

Common care tips

Sequential compression devices are plastic sleeves that wrap around the client’s legs and consist of multiple compartments that are connected to an air pump via a tube. Air is pumped into each compartment, from bottom to top, inflating them. When all compartments are inflated, they deflate, and then the cycle starts again. This cycle helps push the blood from the legs back to the heart.  
Before applying the antiembolic stockings and SCDs, here are some general considerations.

  • Make sure you know what size and length of antiembolic stockings to use for your client. 
  • Make sure that the legs are dry before applying them because this will make it much easier. 
  • Keep in mind that antiembolic stockings and SCDs are contraindicated in clients with ulcers, sores, areas of skin breakdown, dermatitis, or significant edema in the lower legs. Also, they should not be applied in clients with impaired arterial circulation in the lower legs, as indicated by cold or pale skin. If you notice any of these, notify the healthcare provider. 
  • Make sure you know when you should remove the stockings and the SCDs and for how long. 
    • Typically, you will remove them every eight hours for about 30 minutes. 
    • Often, a client is allowed to remove them for the night. Be sure to reapply them in the morning before the client gets out of bed; otherwise, the legs can swell from standing or sitting, and it will then be difficult to put them on.
  • Frequently assess your client’s feet and toes for color, temperature, mobility, sensation, swelling, and pain or discomfort.

Figure 2: Common care tips.

Procedure of applying antiembolic stockings and SCDs

Start by making sure that the wheels on the bed are locked and raise the bed to a comfortable working height. Next, lower the side railings on the working side of the bed.

  1. With the client in a supine position, expose one of their legs (Fig. 3a). 
  2. Hold the antiembolic stocking with both hands, turn the stocking inside out, down to the heel. Slip the foot of the stocking over the client’s toes, foot, and heel, making sure that the heel pocket is properly positioned on the client’s heel (Fig. 3b). 
  3. Pull the top of the stocking up the leg; the stocking will turn itself right side out as you do so. Gently pull the remaining stocking up over the leg (Fig. 3c). Depending on the type, it will either stop at the knee or the thigh. 
    • Remember that the heel pocket should be over the client’s heel and there should be an opening either over or under the toes. 
    • Make sure the stocking doesn’t have any twists or wrinkles. 
  4. Repeat the procedure on the other leg. 

Figure 3: Steps for applying antiembolic stockings. A. Expose one of client's legs. B. Turn stocking inside out down to the heel and slip foot of stocking over client's toes, foot, and heel. C. Pull the top of the stocking up the leg. Check that the opening is either over or under the toes.

Now, for the SCDs:
 
  1. Remove the sleeves from the plastic cover and unfold them. 
  2. Put one sleeve under the client’s leg. The ankle should be lined up with the ankle opening and the back of the knee with the knee opening. 
  3. Wrap the sleeve around the leg and make sure that it fits correctly; you should be able to fit two fingers between the leg and the sleeve. 
  4. Repeat the procedure on the other leg. 
  5. Plug the tube to the air pump and activate the pump; a green light will typically turn on. Check that the compartments are properly inflating and deflating for a full cycle. 

Figure 4: Steps for applying antiembolic SCDs. A. Put one sleeve under client's leg. B. Wrap sleeve around leg, making sure it fits correctly. C. Plug tube into the air pump and activate pump.

Once you’re done with applying the stockings or SCD, assist the client into a comfortable position, return the side rails to the raised position, and lower the bed. 

Documentation

When assisting a client with antiembolic stockings and SCDs, there are a few things you should report to the healthcare provider, like if you observe rapid swelling or redness; or if your client complains of pain, increased temperature, or numbness of their lower leg. Also inform the healthcare provider:
 
  • if the client with SCDs shows any signs of allergic reaction to the elastic such as swelling, redness, or itching 
  • if the client reports any numbness, pain, discomfort, or inability to move their toes 
  • if you notice the skin is pale, cold, swollen, or if there’s absence of the pedal pulses 
    • For clients with antiembolic stockings, you can use the toe opening to see if the skin is pale, cold, or swollen 

Figure 5: Signs and symptoms to look out for.

After the procedure, document:

  • the date, the time you applied the antiembolic stockings or the SCDs, and when you remove them 
  • if you noticed any unusual observations regarding the skin of the client’s legs and feet
  • the size and length of stockings you applied (if you applied antiembolic stockings)