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Use of below-knee products and compliance
This article highlights the need to use graduated compression stockings (GCS) in deep vein thrombosis (DVT) prophylaxis. A survey carried out at the Middlesex Hospital, part of the UCLH NHS Trust, London, ascertains the prevalence of patients wearing either above- or below-knee GCS and whether or not these were worn correctly through two trials. The findings show how the choice of product can influence compliance, safety and economy, which in turn influences adherence to hospital policy.
KEYWORDS Deep vein thrombosis (DVT), Graduated compression stockings, Below-knee stockings
Introduction
Often, deep vein thrombosis (DVT) is preventable (Wallis & Autar 2001) and yet, both DVT and a subsequent pulmonary embolism (PE) remain as significant causes of postoperative morbidity and mortality (Collier 1999, Thomas 1999). The 'average' DVT is thought to increase a patient's stay in hospital by more than one week. However, there are longer-term implications to consider for both the patient and the NHS, for example, DVT increases the risk of developing a chronic condition such as venous ulceration within the post-phlebitic limb (Byrne 2001), with the cost to the NHS of treating ulcer-related problems estimated at approximately £600 million per year (Bosenquet et al 1993).
DVT formation can be due to one or more of three pre-disposing factors identified as Virchow's triad (Geraghty et al 2001, Wallis & Autar 2001):
* A change in the structure of the blood vessels themselves as a result of trauma or direct damage (eg: surgery).
* A change in the body's coagulation mechanisms (eg: as a result of dehydration or with malignancy).
* Stasis of the venous circulation (eg: with bed rest, prolonged immobility or through postoperative immobilisation).
There are certain categories of patients known as being at an increased risk of developing a DVT (Collier 1999):
* Orthopaedic patients, especially those undergoing reconstructive surgery (eg: hip replacements).
* The elderly.
* Those undergoing major surgery, especially pelvic procedures.
* Those with a previous history of DVT or PE.
* Neurological patients, especially those recovering from a stroke who are on prolonged bed care.
With DVTs usually preventable, it is essential for all hospital trusts to have a policy for prophylaxis that is firmly adhered to (O'Neill 2001). Without prophylaxis, the overall risk...
