Fitting anti-embolism stockings and a pneumatic compression device on a patient
Once the correct size of anti-embolism stockingsand intermittent pneumatic compression sleeve has been ascertained, the patient can be fitted with the prophylactic devices. To fit the stocking, first put your hand inside and work towards the foot. Locate the heel of the stocking. They’re usually easy to identify. Some brands may have a different colour or the fabric may be more dense, like this one. Grasp the heel and carefully pull the heel of the stocking out so that it’s inside out.
Ask the patient to place their foot into the stocking ensuring that the heel part of the stocking is under their heel. It’s essential that the patient’s toes are not poking through the end of the stocking as they may become restricted by the elastic surrounding the hole. The hole should be under the foot. This allows nursing staff to check the foot for any discolouration that may indicate a problem with blood flow. Next, gently roll the leg of the stocking up the patient’s leg, ensuring there are no wrinkles.
Nurse:How does that feel?
Patient:It’s a little tight, but it’s okay.
Nurse:Good. It’s important that you remember not to roll down the stockings and if you do have to take them off for any reason, remember to put them back on again. If you need to wash them, that’s fine, but don’t put them in really hot water and don’t put them on top of the radiator. The heat will destroy the lycra in them.
Each of the intermittent pneumatic compression sleeves will have a label indicating which side of the sleeve needs to be placed against the back of the patient’s leg. It will also show which end of the sleeve is the ankle end and which end is the thigh end.
Nurse:Could you slide this under your leg please?
Next, wrap the sleeve up, fastening the Velcro strips to each other. Although the sleeve should be reasonably tight, you should still be able to slide two fingers under the top of the sleeve. Next, attach the sleeve to the machine, ensuring the mechanism is properly connected.
To fit the foot cuff, unwrap it and ask the patient to place their heel into the strap at the back of the cuff. Wrap the cuff back up again and attach it to the machine again ensuring the connection snaps properly into place. Right, we’re all set. Let’s switch the machine on. The machine will self regulate to apply the correct pressure.
Nurse:How does that feel?
Patient:Oooh it’s really nice – it’s like waves going up your leg. The foot cuff is a bit strange; it’s like a deep pressure on the ball of the foot.
Nurse:Good, that’s exactly right.
The wave-like feeling is referred to as the ‘milking’ action .and should mimic the return of the blood from the foot to the heart. The foot cuff should massage the base of the foot, like when you walk, to stimulate blood flow back up the leg.
Patient:What if I need to get up to go to the loo? Can I take it off?
Nurse:Yes, that’s fine but you’ve got to remember to reattach the connections as soon as possible. You shouldn’t leave them unplugged for a long period of time. Most of these devices have a maximum interval when they can safely be left off. Try to wear the sleeves and the cuffs as much as possible.