safe use of thromboembolic disease stockings (TEDs)
The aim of this report is to review a current practice for the safe use of TEDs (thromboembolic disease stockings) within the surgical care setting. The paper reveals that TEDs anti-embolisms stockings assist in preventing and managing the Deep Vein Thrombosis (DVT). Despite the benefits of TEDs stockings within the clinical setting, there are still contraindications in its use, which could affect its safe use. The study collects data from various medical databases, which include, CINAHL (Cumulative Index to Nursing & Allied Health), EBSCO- Medical databases — Biomedical Library, U.S. National Library of Medicine National Institutes of Health, PubMed, and Sage Publication. The keywords are used to search for appropriate data to complete the study.
The data analysis is carried out to enhance reliability and validity of the data. The research findings reveal that nurses could achieve patient’s outcome if they assist patients to use the correct TEDs stockings within the clinical unit. The study recommends that there is a need for further research on the strategy to enhance the safe use of TEDs anti-embolism stockings.
Abstract
Content Outline
1.0: Introduction
1.1: Aim
1.2: Scope
1.3: Background to the Study
2.0: Data collection
3.0: Analysis of Data
4.0: Conclusion
4.1: Recommendations
References
1.0: Introduction
The focus of this project is to review the current practice for safe use of TEDs (thromboembolic stockings) within the surgical care setting. TEDs (Thromboembolic Disease Stockings) are the anti-embolism stockings that are clinically proven by physician to reduce the risk of developing DVT (Deep Vein Thrombosis ). A DVT is a disease that leads to blood clots and generally occurs within the vein of the leg. DVT generally occurs after a patient has undergone a surgery or has experienced a long period of bed rest in the hospital. A symptom associated with DVT is blood clots and could travel from the vein to heart. If the clot becomes loose, it may block a patient’s major blood vessel. A blood clot that leads to the blocking of patient’s blood vessel is known as PE (Pulmonary Embolism).
TEDs anti-embolisms stockings widely being advocated to prevent deep vein thrombosis (Covidien, 2012) and they assist in improving blood circulation in the leg veins. The major benefits of TEDs graduated elastic compression stocking is that they generally reduces the risk of DVT by increasing venous velocity within the deep veins.
“TEDs graduated elastic compression stockings have been designed to deliver a gradient of external pressure, which is highest in the ankle region and lowest in the upper thigh region. These pressures are defined as 18 mniHg at the ankle, HnimHg nt the calf, 8 mmHg at the knee, lOmmHg at the lower thigh and 8 mmHg at the upper thigh, although these can vary slightly depending on the hosiery manufacturer.” (Walker, Lamont 2007 P. 41).
TEDs Anti-Embolism Stockings consist of:
“Thigh Length Anti-Embolism Stockings with Belt (Latex Free),”
“Thigh Length Anti-Embolism Stockings,”
“Knee Length Anti-Embolism Stockings (Latex Free),”
“Continuing Care Anti-Embolism Stockings (Thigh Length).” (Covidien. 2012 P. 2).
“Continuing Care Anti-Embolism Stockings (Knee Length).”
Patients are generally recommended to wear TEDs for two weeks from the day of surgery or the day patients are ready to be admitted to the surgical care units. However, the issue is not the general use that actually causes harm to patients, the issues is the safety of anti-embolism stockings for patients.
While “anti-embolism stockings continue to be widely prescribed. However, there is a limited attention to possible contraindications or complications. There is also poor provision of education and information, poor monitoring and poor documentation regarding their use.” ( Miller, 2011 P. 553).
More importantly, there is a paucity of studies on the safe use of TEDs within the surgical clinical units. The study attempts to fill the gap by collecting data on the importance of TEDs for surgical and post-surgical patients and how its wrong use could cause harm to patients. The report provides the scope on the overall contents that will be covered, and the background of the report reveals the issues that nurses observed and identified while working within the surgical units. Typically, it is apparent that patients could suffer from wearing the wrong stockings after clinical surgery. The report also carries out the data analysis by critically discussing the published literatures relevant to the study. From the analysis of the paper, the report provides various recommendations that would assist nurses to observe the safe use of TEDs of anti-embolism stockings within the clinical units.
1.1: Aim
The paper achieves the following aim:
To review a current practice for the safe use of TEDs (thromboembolic disease stockings) within the Surgical Care setting.
1.2: Scope
The scope of the report covers the current use of TEDs (thromboembolic disease stockings) within the Surgical Care setting. The report also reviews the current practice for the safe use of TEDs. It is essential to realize that the safe use of TEDs is very important to enhance prevention and management of DVT. The report covers the use of TEDs within the clinical practice. Essentially, there are also indications and contraindications with references to TEDs, and the benefits associated with TEDs is that it generally prevents the formation Deep Vein Thrombosis, which assists in increasing the blood flow velocity in the legs. More importantly, the report covers how the use of TEDs could affect the patient’s outcome, and the report provides the recommendations on the safe use of TEDs within the clinical unit. However, the study identifies some contraindication of TEDs; however, the study does not provide elaborate discussion on TEDs contraindication, which reveals that TEDs should not be recommended for patients:
with extreme leg’s deformity with severe arteriosclerosis or With ischemic vascular disease.
TEDs are not also suitable for patients with massive legs’ edema (swelling) or patients with pulmonary edema caused by congestive heart failure.
1.3: Background to the Study
In the United States, Europe and other countries around the world, anti-embolism stockings are widely used in preventing deep vein thrombosis. The DVT and pulmonary embolism (PE) are the form of diseases leading to the blood clot within the veins of the legs, which eventually cause pain, swelling and tenderness of the leg. Typically, hospitalized patients are 100 times more likely to develop DVT or PE compared to people not hospitalized. Yearly, up to 30,000 people are hospitalized in Australia because of consequence of DVT or PE. However, the DVT or PE cases could be prevented with the use of TEDs graduated compression stockings. (National Health and Medical Research Council, 2009).
Despite the importance of TEDs in enhancing the blood circulation, safe use of anti-embolism stocking has become challenging within the surgical care unit. Nurses, and doctors are the major players in the patient’s outcomes, and the safe use of TEDs is very critical to enhance healthy outcomes of patients. However, nurses are increasingly observing some issues while working in the surgical units of private hospitals. Some of the issues identified within the surgical units that could cause harm to patients with the use of TEDs include:
wrong measurement of patient’s leg or calf;
wrong size stockings nurses are not sure how to deliver the accurate measurements, calf or leg after surgery swells, another pair of TEDs need to be fitted;
TEDs difficult to apply too tight wear;
too big and cause harm to patient;
patient not complying with nursing instruction;
Not wearing the TEDs again after shower.
Based on the issues identified, the study attempts to overcome the challenges with the wrong use of TEDs by reviewing the safe use of TEDs within the Surgical Care setting. The data collected through the literature analysis assists the study to identify the safe use of TEDs with the clinical units.
2.0: Data collection
This section discusses the method of data collection, which involves the strategy that the study uses in collecting data to complete the study. The study collects data from various academic databases, which include:
CINAHL (Cumulative Index to Nursing & Allied Health)
EBSCO- Medical databases — Biomedical Library,
U.S National Library of Medicine National Institutes of Health,
PubMed;
Sage Publication,
The study sources for high quality data from the medical database. CINAHL is one of the important databases that the study uses to source for data. CINAHL contains comprehensive number journals and research articles relevant to DVT and TEDs anti-embolism stockings. The report takes the advantage of easy-to-use interface that CINAHL delivers to search for reliable research articles relevant to study. The CINAHL contains indexing of more than 1,700 nursing and allied journals and publications that contain more than one million records. The CINAHL database contains research papers on biomedicine, nursing, health sciences, alternative complementary medicine, and other 17 allied health disciplines. Among examples of the topics covered by CINAHL, include.
Deep Vein Thrombosis (DVT),
PE (Pulmonary Embolism),
Thromboembolic Disease Stockings and,
Effectiveness of TEDs in managing Deep Vein Thrombosis.
Moreover, the CINAHL database offers access to health and nursing dissertation on Deep Vein Thrombosis (DVT), PE (Pulmonary Embolism), Thromboembolic Disease Stockings, and effectiveness of TEDs in managing Deep Vein Thrombosis.
Moreover, EBSCO, U.S. National Library of Medicine National Institutes of Health, PubMed, and Sage Publication databases also contain thousands of research articles on the TEDs, DVT, Pulmonary Embolism, Anti-Embolism Stockings and the safe use of TEDs within the clinical units.
To identify the articles and research papers relevant to the study, the paper uses the keywords to search for data from the database and the keywords include:
Deep Vein Thrombosis (DVT )
TEDs (thromboembolic disease stockings)
PE (Pulmonary Embolism).
TEDs Anti-Embolism Stockings
Prevention of DVT,
The goal of using the keywords is to search the articles and research papers relevant to the study. When the author submits the keywords to the database, numerous articles come out from the database and the study only selects the articles that relevant to complete this study. Using the relevant search strategies, the author has been able to source for the quality research papers to complete the study.
3.0: Analysis of Data
Data analysis is the process of cleaning, inspecting, and transforming the data with the goal of delivering valid and reliable research paper to enhance decision-making. Data mining is the data analysis technique that the study uses in screening the reliable data from the database since the goal of this study is to produce high quality data to complete the study.
One of the best methods to check the data reliability is to check the abstracts of all the data collected to ensure that the overall structure of the data are relevant to the study. After checking the abstracts, all data relevant to the study are selected and those not relevant are discarded.
Another strategy used for the data analysis is to review the articles from peer-reviewed journal. Since not all published medical materials have the same credibility, the author specifically uses the peer-reviewed articles for the report. The peer-reviewed articles have more authorities because they have been properly scrutinized and approved by scholars, and the study specifically handpicked the articles from the peer-reviewed journals. The benefits of using peer-reviewed journals are that the articles published in the peer-reviewed journals have already undergone extensive process to improve on the quality of the articles before being accepted for publication.
Typically, many of the medical journals used for the report are peer-reviewed journals that have undergone critical evaluation before being published. It is essential to realize that peer-reviewed articles have already undergone series of evaluation from editorial staff, who improve, and edit the articles to remove the flaws identified within the articles. For example, the Annals of Internal Medicine receives 1200 submissions yearly; however, only 15% are subsequently published. Thus, the strength of peer-reviewed is that it has become an accepted method to carry out data analysis. (William, 2006).
Covidien (2012) provides overview of TED anti-embolism stockings. The author shows the complication that patients could have with Deep Vein Thrombosis, which can lead to major health risks to patients. Thus, the report reveals that TEDs are the clinical proven anti-embolism stockings that could be used to prevent and manage complications associated with Deep Vein Thrombosis. Essentially, “TEDs Anti-Embolism Stockings improve blood circulation in the leg veins by applying graduated compression.” ( Covidien, 2012 P. 7). Despite the important of anti-embolism stockings for the prevention and management of DVT, not all anti-embolism stockings have the same level of direct clinical evidence protection.
Thompson et al. (2011) also reveal that anti-embolism stockings (AES) are the effective clinical tools that decrease the risk of DVT. Typically, the AES decreases the effect of DVT on patients who have undergone a general surgery. Thus, the authors further reveal that risk of developing DVT after total knee replacement (TKR) or total hip replacement (THR) without any thromboprophylaxis is nearly 56%. However, the risks are lower to 37% with the application of compression stockings. (Agu, Hamilton, and Baker,1999).
University of Edinburgh (2010) also presents data on the graduated compression stockings, where author reveals that the graduated compression stockings are widely used to manage deep venous thrombosis prophylaxis. However, the authors argue that below knees stockings are widely used than the thigh-length stockings. Typically, DVT and pulmonary embolism are common among patients specifically hospitalized for surgery as well as patients associated with immobility and stroke. DVT could lead to an avoidable death and graduated stockings are widely used to prevent and manage the risk of DVT. However, the findings delivered by the author show that incorrect use of TEDs stockings could lead to skin problems for patients wearing thigh-length stockings, and patients using below-knee stockings.
Walker & Lamont, (2008) also focuses on the correct use of graduated elastic compression stockings in the prevention of the DVT for surgical patients. Typically, prophylaxis against DVT is critical in nursing care, and graduated elastic compressions increases the velocity of blood in the veins thereby reducing the risk of thrombus formation.
Miller, (2011) show that anti-embolism stockings are the effective clinical tool for the prevention of DVT. Typically, anti-embolism stockings are effective in reducing the pain within the overall cross-sectional area of the limb as well as increasing velocity of venous within the limb. More importantly, anti-embolism stockings have also been demonstrated to reduce the relative risks of DVT that surgical patients may develop after surgery. To enhance effective utilization of anti-embolism stockings for the prevention of DVT, stockings must be correctly sized. The data collected from the authors reveal that anti-embolism stockings prevents patients who have undergone surgical operation to develop the risk DVT, and the risk for surgical patient generally reduces by 60-80%.
While there are several elastic compressions that could be used to manage DVT, however, not all the graduated elastic compression is effective for the prevention and management of DVT. The data collected on TEDs reveals that TEDs are long, tight fitting anti-embolism stockings that assist in providing graduated pressure on the legs. Despite the importance of TEDs, proper size and fittings of the stockings is critical to make the TEDs to be effective and safe for patient’s use. Typically, nurses could only provide the safe use if the stockings are in the proper size and fit for patients.
4.0: Conclusion
The goal of this study is to review the “current practice for safe use of thromboembolic disease stockings (TEDs) within the Surgical Care Unit.” The report identifies DVT as the most recognized common diseases among patients who undergo surgery in the hospital. Typically, DVT may lead to pulmonary embolism, which may consequently lead to death. The report identifies TEDs Anti-Embolism Stockings as the clinical methods to manage and prevent DVT. Despite the benefits of anti-embolism stockings for the prevention and management of DVT, the important issue is that not all the anti-embolism stockings are safe for patients. Typically, there is still contra-indication associated with the anti-embolism stockings because they could not be recommended for all patients suffering from DVT. The report also reveals that not all anti-embolism stockings have the same level of clinical benefits. Evaluation of TEDs anti-embolism stockings reveals that TEDs anti-embolism stockings could deliver high benefits for patients. However, medical practitioners need to critically evaluate the TEDs stockings before allowing patients to use during the clinical settings to enhance patient’s healthy outcomes.
4.1: Recommendations
Correct selection of anti-embolism stockings is very critical to enhance patient’s safety. The report recommends that medical practitioners should provide correct fitting of stocking for patients to enhance patient’s safety. Typically, correct fitting will avoid discomfort or skin irritation, which maximize patient outcome. Thus, patients must strictly follow the instruction directed by physicians or nurses on the method to wear the stocking to enhance patient’s safety. The stockings should also be changed every 2 or 3 days. The report recommends the following precautions with the use of stockings:
1. Patients should not roll their stocking downward in order not to impede the blood flow.
2. It is critical not to turn down the top of the stockings;
3. Patients should not use their knee length stockings to cover portion of their knee.
There is a need to carry out a further research on the method to enhance effective safety use of TEDs anti-embolism stockings for the prevention and management of DVT.
List of References
Agu, O., Hamilton, G., and Baker, D. (1999). Graduated compression stockings for the prevention of venous thromboembolism. British Journal of Surgery, 86- 992-1004.
Covidien. (2012).T.E.D. â„¢ Anti-Embolism Stockings. Fastus Library. Covidien Company.USA.
National Health and Medical Research Council (2009). Guideline of Clinical practice for the prevention of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to Australian hospitals. Commonwealth of Australia 2009.
Miller, J.A. (2011). Use and wear of anti-embolism stockings: a clinical audit of surgical patients. International Wound Journal. 8 (1):74-83.
Thompson, a. Walter, S. Brunton, L.R. et al. (2011). Anti-embolism stockings and proximal indentation. British Journal of Nursing, 20 (22): 1426- 1430.
University of Edinburgh,(2010). Below-Knee Stockings vs.Thigh-Length for Deep Venous Thrombosis Prophylaxis After Stroke. Annals of Internal Medicine.153(9):553-562.
Walker L. & Lamont, S. (2008) Graduated compression stockings to prevent deep vein thrombosis.Nursing Standard. 22, (40): 35-38.
Walker, L. Lamont, S. (2007). Use and application of graduated elastic compression stockings. Nursing Standard.. 21 (42):41-45.
William, F.M. (2006). Finding Truth from the Medical Literature: How to Critically Evaluate an Article. Prim Care Clin Office Pract. 33: 839 — 862.
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