Pre‐procedure

ActionRationale

1. 1.Show
   Assess and record in the patient's documentation the patient's risk factors for VTE (DVT and PE).
   All patients admitted to hospital should undergo a risk assessment for venous thrombosis to determine the most appropriate thromboprophylaxis (Farge et al. [60], R; NICE [148], C; SIGN [191], C). The higher the number of risk factors, the greater the risk of VTE (NICE [148], C; SIGN [191], C).
2. 2.Show
   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 16.6).
   To comply with national guidelines and hospital policy/guidelines. To ensure that antiembolic stockings are used appropriately (All Wales Tissue Viability Nurse Forum [11], E; Farge et al. [60], E; NICE [148], C; SIGN [191], C).
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [152], C).

Procedure

1. 3.Show
   Perform hand hygiene and put on an apron prior to the procedure.
   To prevent cross‐infection (NHS England and NHSI [137], C).
2. 4.Show
   Measurement for thigh‐length stockings:

   1. Measure upper thigh circumference at the widest part of the thigh (Action figure 5a).
   2. Measure calf circumference at the widest part of the calf (Action figure 5b). Note: refer to individual manufacturers’ instructions to ensure that no other measurements are necessary, e.g. length of leg.
   3. Consult the product packaging to determine the appropriate size.

      • If right and left legs measure differently, order two different stocking sizes.
   To comply with the manufacturer's instructions. E

   Incorrect sizing causes swelling and bruising to ankles and can constrict blood supply, leading to long‐term complications. E
   • • If thigh or calf circumference is greater than that stocked by the manufacturer, then refer to local trust guidelines to determine the appropriate course of action. In some cases, knee‐length stockings may be more appropriate.
   It has also been suggested that 15–20% of patients cannot effectively wear thigh‐length antiembolic stockings because of unusual limb size or shape (SIGN [191], C).
   Measurement for knee‐length stockings:

   1. Measure calf circumference at the widest part of the calf. Note: refer to individual manufacturers’ instructions to ensure that no other measurements are necessary, e.g. length of leg.
   2. Consult the product packaging to determine the appropriate size.
   3. If the right and left legs measure differently, order two different stocking sizes.
    
   Order two pairs of stockings.
    
3. 5.Show
   Apply the stockings:

   1. Insert hand into stocking as far as the heel pocket.
   2. Grasp centre of heel pocket and turn stocking inside out to heel area.
   3. Position stocking over foot and heel, ensuring the patient's heel is centred in the heel pocket (Action figure 6a).
   4. Pull a few inches of the stocking up around the ankle and calf (Action figure 6b).
   5. Continue pulling the stocking up the leg as described in the manufacturer's instructions. When using thigh‐length stockings, the top band rests in the gluteal furrow.
   6. Smooth out wrinkles.
   7. Align the inspection window to fall under the toes (toes should not stick out).
   To ensure the appropriate size of stocking is fitted correctly. E

   Thigh‐length stockings are difficult to put on and can roll down, creating a tourniquet just above the knee that restricts blood supply, so patient monitoring and/or assistance should take place to ensure that stockings are fitted smoothly, are not rolled down or have the top band folded down (SIGN [191], R; Todd [203], R; Wounds UK [235], R).

Post‐procedure

1. 6.Show
   Document the leg measurements and the size of stockings applied in the nursing records. Instruct the patient and provide written information about the following:

   1. reasons for wearing antiembolic stockings
   2. how to fit and wear stockings
   3. what to report to the nurse, e.g. any feelings of pain or numbness and any skin problems
   4. skin care: wash and dry legs daily, applying emollient if clinically indicated
   5. reasons for early mobilization and adequate hydration
   6. reasons for not crossing legs or ankles: to prevent constriction of blood supply
   7. length of time that the stockings should be worn, e.g. stockings should be removed for a maximum of 30 minutes daily and worn until the patient returns to their usual level of mobility.
   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 (e.g. pressure sores or circulation difficulties of wearing antiembolic stockings) (NICE [148], C; Wade et al. [216], R).