Cardiovascular: Applying antiembolic stockings and sequential compression devices

Αs a nursing assistant, 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.

But first thing’s first: In deep vein thrombosis, deep vein refers to veins that run between the muscles as opposed to superficial veins that you can see on the surface and thrombosis refers to blood clot formation.

So a DVT is a blood clot in one of those deep veins, and it typically involves the deep veins of the lower legs or thighs. An individual with DVT will often complain of rapid swelling, redness, and pain on the lower leg.

The bad news is that it can lead to life threatening conditions, such as pulmonary embolism where a broken off piece of the clot called an embolus travels to the lungs and causes respiratory problems.

Alright, antiembolic stockings and SCDs can be used to prevent DVTs. 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. Now, 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.

Now, 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. Now, before applying the antiembolic stockings and SCDs, here are some general considerations.

Be sure to check with the nurse, so you know what size and length of antiembolic stockings to use for your client.

Also, 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, let the nurse know. Make sure to ask the nurse when you should remove the stockings and the SCDs and for how long.

Typically, you will remove them every 8 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.

Ask the nurse how often you should check the client’s feet and toes for color, temperature, mobility, sensation, swelling, and pain or discomfort.

Alright, now let’s discuss the procedure of applying antiembolic stockings and SCDs step by step.

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.

With the client in a supine position, expose one of their legs. 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.