Mechanical prevention of venous thromboembolism: stockings and intermittent compression

What it is

Venous thromboembolism (deep vein thrombosis and pulmonary embolism) is a common and largely preventable complication of hospital care: about half of new cases occur during a hospital stay or within 90 days after it. Prevention combines risk assessment on admission, early mobilisation and, as ordered, drug or mechanical measures. The mechanical ones are graduated compression stockings and intermittent pneumatic compression devices, which increase venous flow in the legs. Nursing applies them correctly, checks the skin, watches adherence and picks up the signs of thrombosis.

Indications

• Patients at risk of thromboembolism on the admission assessment, by medical order.
• After surgery, prolonged bed rest or immobility.
• Patients at high bleeding risk, in whom the doctor prefers mechanical measures.

Contraindications and precautions

• Signs of deep vein thrombosis already present: do not apply the device and report.
• Wounds, ulcers, dermatitis or fragile skin on the legs, or marked oedema: ask before applying.
• Broken skin or marked swelling of the leg: it needs medical assessment before compression is applied.
• Use the right size from the leg measurement and the manufacturer's instructions.
• Stockings may increase fall risk: non-slip footwear when walking.

Equipment

• Graduated compression stockings of the prescribed size and length.
• Intermittent pneumatic compression device with its sleeves and pump.
• Tape measure to measure the leg.
• Supplies to check and moisturise the skin.

Step by step (and why)

1. Check the order and the device, identify the patient and explain — adherence depends on understanding why.
2. Assess both legs: skin, pulses, temperature, oedema and signs of thrombosis — if there are signs of thrombosis, do not apply and report.
3. Measure the leg as the manufacturer directs and choose the size — a stocking that does not fit squeezes too much or does nothing.
4. Apply stockings with no wrinkles or rolled edges — a wrinkle acts as a tourniquet and injures the skin.
5. Fit the sleeves snugly, connect them and check that the pump cycles — if it does not inflate, it does not protect.
6. Check skin and circulation at least once a shift or per protocol — picks up pressure injury from the device.
7. Remove them for short periods to wash and check the skin, then put them back — they only protect while worn.
8. Encourage mobilisation and ankle exercises, and record application, skin and adherence — mobilising also prevents.

Complications

• Skin or pressure injury under the stockings or sleeves.
• Excess compression from the wrong size or poor application, with impaired circulation.
• Falls when walking in stockings or with the sleeves connected.
• Poor adherence: the device is left off and does not protect.

Next step: when to call for help

• Report at once swelling of one leg, redness, warmth or pain in the calf.
• Activate the emergency response if sudden breathlessness, chest pain or coughing up blood appear.
• Report if the skin under the device is injured, pale, cold, purple or has lost sensation.
• Report if the patient refuses or cannot tolerate the device, so prevention can be reassessed.

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: CDC Grand Rounds: Preventing Hospital-Associated Venous Thromboembolism (CDC, Morbidity and Mortality Weekly Report, 2014); Nursing Assistant, 11.2: Cardiovascular System (Chippewa Valley Technical College, Open RN remix (LibreTexts), 2022).

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Representative model, for educational purposes only.