title: Clinical thromboembolic detterrent stockings application: are thromboembolic detterrent stockings in practice matching manufacturers application guidelines.
abstract: BACKGROUND
  Thromboembolic detterrent (TED) stockings have been shown to be effective in the reduction of thromboembolic events in post operative patients. These manufactured stockings create graduated compression from ankle to calf.
  
  
  OBJECTIVE
  To assess whether the manufacturers' recommendations for application were being met in a District general hospital setting and whether this achieved the desired gradient of compression.
  
  
  METHODS
  We carried out pressure measurements on 100 legs in post-operative patients and recorded reasons for poorly fitting stockings. Pressure measurements were taken at standard positions around calf and ankle using a pre-calibrated subbandage pressure measuring device.
  
  
  RESULTS
  About 20% of stockings were worn incorrectly by patients. Median pressure applied at the ankle was 13 mmHg (range, 6.5-18.5) compared to the manufacturers' intended compression of 18 mmHg. Only 14% of the stockings showed an acceptable gradation of reduced pressure between ankle and calf. About 23% of the stockings exerted a positive pressure at calf level compared to the ankle.
  
  
  CONCLUSIONS
  Most TED stockings do not produce a standardised Siegel profile pressure gradient decrease from ankle to calf. This may be due in part to fluid changes after surgery in combination with the large variation in size of lower limbs. Our District general hospital utilises three of the six sizes of TED stocking, and remeasurement was not taking place every 24 h as per guidance. This as the result show not only negates the benefit of TED stockings but may also exert harm in terms of venous thromboembolism risk. This finding adds further weight to the argument of whether TED stockings may not be having the desired prophylactic effect and may even be resulting in harm in select cases.
authors.affiliation: Peninsula Deanery, Torbay, UK kirk_bowling@hotmail.com.
authors.forename: K
authors.initials: K
authors.lastname: Bowling
authors.affiliation: Wales Deanery, Vascular Surgery Unit, Wrexham, UK.
authors.forename: C
authors.initials: C
authors.lastname: Ratcliffe
authors.affiliation: Wales Deanery, Vascular Surgery Unit, Wrexham, UK.
authors.forename: J
authors.initials: J
authors.lastname: Townsend
authors.affiliation: Wales Deanery, Vascular Surgery Unit, Wrexham, UK.
authors.forename: U
authors.initials: U
authors.lastname: Kirkpatrick
mesh_terms: D019983:Guideline Adherence; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control*; D011312:Pressure; D053828:Stockings, Compression / Q000009:adverse effects / Q000592:standards*; D013923:Thromboembolism / Q000517:prevention & control*
keywords: Calf vein thrombosis; compression stockings; deep vein thrombosis; hospital-acquired venous thromboembolic disease