4.9 Anti-Embolism Stockings

Tracy M. Christianson, RN, BSN, MN, DHEd, CCNE; Kimberley Morris, RN, BN, MN

4.9 Anti-Embolism Stockings

Some clients may be prescribed by their doctor special compression or anti-embolism stockings to wear on their legs. Anti-embolism stockings help force blood in superficial veins of the legs to deeper veins, prevent stagnation of blood in the veins of the legs, and promote venous return to the heart (Sorrentino, et al., 2019; Taylor, et al., 2001). A physician’s order is required for their use. These types of stockings are used for clients with poor circulation, who have limited activity, or are at risk for getting a blood clot. They are also used to help prevent or reduce swelling.

Several manufacturers produce men’s and women’s stockings that apply pressure to the legs from the foot to mid-thigh or higher. Some apply mild pressure; others apply pressure equivalent to that of an elastic bandage. Anti-embolism stockings are made of elastic material and available in either knee-high or thigh-high length. They are also available in a variety of colours. Many people who are on their feet or remain in one position a great deal, such as HCAs, nurses, salespeople, and businesspeople, find them useful. The stockings should be fitted correctly to the person’s measurements.

Stockings should be placed on the client’s legs prior to the client getting out of bed in the morning, to prevent blood pooling in the lower legs which causes swelling (Sorrentino, et al., 2019; Taylor, et al., 2001). Follow the instructions written in the Care Plan for guidelines for when to apply, how long the client should wear these stockings each day, and when to remove the stockings. Anti-embolism stockings should always be removed during morning care, the legs inspected, and the stockings reapplied before the client is out of bed.

General Guidelines

Apply the stockings in the morning before the client is out of bed and while the client is supine.* Some stockings fit only the left (L) or right (R) leg. If the client is sitting or has been up and about, have the client lie down with their legs and feet well-elevated for at least 15 minutes before applying the stockings. After the leg vessels are congested with blood, the effectiveness of the stockings is defeated.
Do not massage the legs. If a clot is present, it may break away from the vessel wall and circulate in the bloodstream.
Check the legs regularly for redness, blistering, swelling, and pain. Some people recommend checking the legs at least once every eight hours; others recommend twice a day.
The stockings should be removed completely once a day.
Launder the stockings as necessary, but at least every three days, as soiled stockings irritate the skin.
Always ensure there are no wrinkles in the stockings, as these can cause pressure sores to develop.

Table 4.9 Anti-Embolism Stockings Procedure
STEP	ACTION	REASON
1.	Explain the procedure to the client. Ensure they understand the importance of wearing these elastic support stockings. Seek guidance from a supervisor as needed, and report refusal to wear stockings.	Figure 4.9.1 Styles of Stockings
2.	Wash and dry your hands.
3.	Assemble equipment, for example: support stockings lotion shoes
4.	If the client has been moving around out of bed, have them lie down with their legs elevated for 15 minutes before applying the stockings.	Decrease any accumulated blood in the lower extremities
5.	Make sure legs are clean and dry. Observe skin for condition and changes, such as sores, swelling, and changes in color. Make note of any observed changes and any client complaints, such as numbness, pain, or tingling in the lower extremities.	Allows you to advise your supervisor right away, as the client may require medical care.
6.	You may use powder or lotion on the client’s legs before applying the stockings.	This provides comfort to the client, eases the application of stockings, and protects the client’s skin.
7.	Raise the bed to waist height. Position client in the supine (lying on back) position.
8.	Apply stockings according to the Care Plan and as a supervisor directs.
9.	Place your hand and arm inside one stocking and turn it inside out up to the heel of the stocking. Grasp the heel of the stocking with your fingers of the hand holding the stocking. If the stockings do not appear to fit well and appear to be digging into the top of the client’s leg, inform a supervisor right away.	If the stocking does not fit well, the client may need to be refitted for the appropriately sized stocking.
10.	Move the stocking down over your arm so that the length of the stocking is now bunched near your hand.
11.	Carefully take the client’s foot and position the opening of the stocking that is near your hand over the client’s toes.
12.	Place the foot of the stocking over the client’s toes, then over the foot, then over the heel. Pull the stocking up slowly as you move it upwards over the client’s leg.
13.	Gently pull the top of the stocking up over the entire calf. Smoothing out all wrinkles.	Help to prevent skin breakdown
14.	Make sure the heel of the foot is in the heel pocket of the stocking.
15.	If there are no toe openings, gently pull on the tip of the stocking by the toes to relieve pressure. For stockings with toe openings, the client’s toes should be positioned appropriately in the toe area.	Allow circulation to be readily assessed
16.	Repeat with the other leg.
17.	Discard gloves if you are wearing them, and wash your hands.	Prevent spread of infection
18.	Report and record any changes in skin color, temperature, swelling, sores on legs, and client complaints.

Watch the video:

How to Help with Compression Stockings – Tips for Caregivers by CareChannel (2019).

Summary:

The promotion of client comfort is a critical component of the care provided by healthcare providers. Because one of the main objectives of implementing hygiene procedures is the achievement of results related to comfort and well-being, it is important to note that client comfort is a therapeutic goal of the care team.

The procedures performed to meet personal hygiene needs are not complicated, but they are very important as they promote comfort and are part of the daily basic nursing care routine. Assisting clients with personal hygiene, or doing these tasks for them, also gives them a sense of safety and security, and assures that clients’ basic needs are understood — and their needs are being met!

Learning Exercises

When providing perineal care to clients (male or female) always work from dirtiest to cleanest.
1. True
2. False
Perineal care is part of morning care and does not need to be done at other times if the client is soiled or wet.
1. True
2. False
Good Hygiene:
1. Is relaxing
2. Prevents body and breath odors
3. Cleanses the body
4. Increases circulation
5. All of the Above
What are the areas washed when giving a partial bed bath. (select all that apply)
1. Face
2. Feet
3. Perineal area
4. Buttocks
5. Axillae
6. Back
7. Hands
8. All of the above
When giving care you should wear gloves at all times
1. True
2. False
As a Health Care Assistant, it is important for you to observe the client’s teeth and gums. What signs of early problems would you report promptly?
1. Bleeding, swelling or redness of the gums
2. Rough sharp or chipped areas on dentures
3. Dry, cracked, swollen or blistered lips
4. Missing or loose teeth
5. Foul breath
6. All of the above
A complete bed bath:
1. Involves washing the entire body while the client is still in bed
2. Is used when the client can complete most their care on their own
3. Is given to all clients
4. Involves bathing the face, hands, axillae, back, buttocks and perineal area
Which of the following is the correct way to wash the female perineal area:
1. Wash in a circular motion from the outside to inside
2. Wash from the anal area toward the urtethra
3. Wash from the urethra to the anal area
4. Wash back and forth over the entire area several times
A back massage:
- A. Relaxes muscles and stimulates circulation
- B. Is a part of morning and evening care.
- C. Should last 3-5 minutes
- D. Allows the HCA time to observe the clients skin condition
1. A, B, C
2. A, B, D,
3. All of the above
4. B, C, D
5. A, C, D
The presence of bleeding gums during oral hygiene procedures is usually a sign of inflammation and means less mouth care is needed.
1. True
2. False

Chapter 4 Attributions and References

Unit 4.2 Image Attributions

Figure 4.2.1 Dental Supplies from PxHere, is used under a CC0 Public Domain licence.
Figure 4.2.2 Oral Health and Aging: Information for Caregivers, by the National Institute of Dental and Craniofacial Research (2019), is used under a CC0 Public Domain licence.
Figure 4.2.3 Types of Partial Dentures from Authority Dental, is used under a CC BY 2.0 licence.
Figure 4.2.4 Denture Container by Authority Dental, via Flickr, is used under a CC BY 2.0 licence.
Figure 4.2.5 Cleaning denture with denture brush technical picture by Authority Dental, via Flickr, is used under a CC BY 2.0 licence.
Figure 4.2.6 Turquoise dental floss sticks by Marco Verch, via Flickr, is used under a CC BY 2.0 licence.

Unit 4.3 Image Attributions

Figure 4.3.1 Transfer Bench by Roger Mommaerts via Wikimedia Commons, is used under a CC BY-SA 2.0 licence.
Figure 4.3.2 Mitt Technique by HCA Program/ Thompson Rivers University, is used under a CC BY 2.0 license.
Figure 4.3.3 Cleaning Eyes by HCA Program/ Thompson Rivers University, is used under a CC BY 2.0 license.

Unit 4.4 Image Attributions

Figure 4.4.1 Female Perineal Care by HCA Program/ Thompson Rivers University, is used under a CC BY 2.0 license.
Figure 4.4.2 Male Perineal Care by HCA Program/ Thompson Rivers University, is used under a CC BY 2.0 license.

Unit 4.5 Image Attributions

Figure 4.5.1 Back Rub Motions by T. Christianson, HCA Program/ Thompson Rivers University, is used under a CC BY 2.0 licence.

Unit 4.6 Image Attributions

Figure 4.6.1 Wet Shave by Lbeaumont, via Wikimedia Commons, is used under a CC BY-SA 4.0 licence.
Figure 4.6.2 Photo of a man getting his beard shaved, by RODNAE Productions, from Pexels.com, is used under the Pexels License.

Unit 4.7 Image Attributions

Figure 4.7.1 Person Getting a Nail File by RODNAE Productions, on Pexels.com, is used under the Pexels License.
Figure 4.7.2 Pedicures by Amy the Nurse, via Flickr, is used under a CC BY-NC-ND 2.0 license.

Unit 4.9 Image Attributions

Figure 4.9.1 Knee-high and thigh-high anti-embolism compression stockings by Lentpjuve, via Wikimedia Commons, is used under a CC BY-SA 4.0 licence.

Videos

How to help with tooth brushing, by CareChannel (2019) [St. Elizabeth Foundation] is licensed under a Standard YouTube License.
Denture Care (How to Care for Someone’s Dentures), by CareChannel (2019) [St. Elizabeth Foundation] is licensed under a Standard YouTube License.
Chapter 1- Considerations for AM Care – BCcampus, written and produced by Chantal Lortie and Natasha Fontaine (2022), from Selkirk College and COTR, and licensed under a CC BY-NC 4.0 licence.
Chapter 2- Before Beginning AM Care – BCcampus, also written and produced by Chantal Lortie and Natasha Fontaine (2022), from Selkirk College and COTR, and licensed under a CC BY-NC 4.0 licence.
Personal Care – Health Care Playlist, watch the Personal Care (Chapters 3–10) videos, from BCcampus. These videos were written and produced by Chantal Lortie and Natasha Fontaine (2022), from Selkirk College and College of the Rockies (COTR), and licensed under a CC BY-NC 4.0 licence.
Backrub Skills Demonstration by Frances Payne Bolton School of Nursing (2010) is licensed under a Standard YouTube License.
Helping Someone Shave, presented by CareChannel (2019) [St. Elizabeth Foundation] is licensed under a Standard YouTube License.
How to Care for Nails, presented by CareChannel (2019) [St. Elizabeth Foundation] is licensed under a Standard YouTube License.
How to Help with Getting Dressed – Caregiver Tips, presented by the St. Elizabeth Foundation on YouTube CareChannel is licensed under a Standard YouTube License.
How to Help with Compression Stockings – Tips for Caregivers by CareChannel (2019)is licensed under a Standard YouTube License.

References

McLain, K., Wade, A., & O’Hara-Leslie, E. (2018, April 27). Foundations for assisting in home care. SUNY Broome Community College. https://textbooks.opensuny.org/foundations-for-assisting-in-home-care/

National Institute of Dental and Craniofacial Research (2019, July). Oral health and aging: Information for caregivers [PDF]. National Institute of Health/ US Government. https://www.nidcr.nih.gov/sites/default/files/2019-09/oral-health-aging-brushing.pdf

Open Learning Media. (2012). HCA program [Digital images]. Thompson Rivers University.

Sorrentino, S., Remmert, L. N., & Wilk, M. J. (2017). Mosby’s Canadian textbook for the support worker. Elsevier (4th ed.) Elsevier Canada.

Taylor, C., Lillis, C. & LeMone, P. (2001). Fundamentals of nursing: The art and science of nursing care. Lippincott, Williams & Wilkins.

License

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Personal Care Skills for Health Care Assistants Copyright © 2023 by Tracy Christianson and Kimberly Morris, Thompson Rivers University. is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.