Anti-embolism stockings: are they used effectively and correctly?

Sensitivity of the properties of the graduated compression stocking and soft tissues on the lower limb-stocking interfacial pressure using the orthogonal simulation test

Graduated compression stocking (GCS) plays an important role in the treatment of venous disease in the lower limb. However, the effect of the variation in the mechanical properties of the GCS and the soft tissues on the treatment of the venous disease in the lower limb remains unclear. The aim of the present study was to investigate the influence of the material properties of the GCS and soft tissues on the lower limb-stocking interfacial pressure using the orthogonal simulation test. A three-dimensional finite element (FE) model of the lower limb was established using the MRI dataset of a 40-year-old volunteer. The bones, the skin, the veins and the skeletal muscles were reconstructed in the FE model. The FE model of the GCS was generated using the information provided by the manufacturer. Then the parameter sensitivity analysis was performed using a two-step orthogonal simulation test. The first-step orthogonal test showed that the variation in the Young's modulus in the wale direction of the GCS induced a change of 0.37 mmHg in the lower limb-stocking interfacial pressure in the ankle section. The second-step orthogonal test showed that the variations in the Young's modulus in the wale direction of the GCS in the knee section induced the changes of 0.05 mmHg, 0.15 mmHg and 0.60 mmHg in the interfacial pressure in the ankle, the calf and the knee, respectively. In conclusion, the Young's modulus in the wale direction of the GCS and the Poisson's ratio of the GCS are the parameters significantly influencing the lower limb-stocking interfacial pressure. The interfacial pressure in the ankle is not sensitive to the Young's modulus in the wale direction of the GCS in the knee section. However, the interfacial pressures in the calf and knee are sensitive to the Young's modulus in the wale direction of the GCS in the knee section. These data provide important information for the design of GCS.

Deep vein thrombosis and Caesarean section

Deep vein thrombosis (DVT) presents a significant risk for women requiring Caesarean section. Venous thromboembolism (VTE) remains the leading direct cause of maternal death in the UK and is the second most common cause of maternal death worldwide, accounting for 11% of maternal deaths (RCOG 2009). This article uses a reflective cycle to explore the role of the preoperative practitioner in the prevention of DVT for women undergoing elective Caesarean section.

Use and wear of anti-embolism stockings: a clinical audit of surgical patients

The objective of this study was to determine if anti-embolism stockings are fitted and worn according to evidence-based guidelines in surgical patients. The methodology is that an observational study was undertaken during January and February, 2010. An audit tool was constructed for the recording of information on a variety of parameters relating to the correct fitting and wearing of anti-embolism stockings. The results show that eighty surgical patients were audited with a mean age of 66 years. Of these, 72.5% were ambulatory; 38.75% of patients had incorrect presentation of their stockings; 29% were fitted with the incorrect size for limb measurement and 70% of patients reported not receiving any information regarding the reason for anti-embolism stocking use. Written information was not received by 100% of participants. For 82.5% of participants deep vein thrombosis (DVT) risk was not recorded. The garment size fitted (and/or limb measurement) was not recorded for 100% of patients. Daily routine skin inspection was noted for 29%. The findings of this study showed that anti-embolism stockings were not fitted and worn according to evidence-based guidelines. The author recommends a new recording tool be developed to ensure consistency of assessment and documentation regarding risk assessment, contraindications identification, and education and monitoring of patients wearing anti-embolism stockings.

Heel damage and epidural analgesia: is there a connection?

OBJECTIVE

To determine heel pressure injury prevalence in surgical patients prescribed epidural analgesia and identify intrinsic and extrinsic factors associated with heel damage in this patient cohort.

METHOD

A descriptive study was used to investigate intrinsic and extrinsic variables associated with recorded heel observations at a private hospital in Victoria, Australia. We recruited a sample of 29 consecutive non-emergency participants undergoing general anaesthesia for major surgery, who were prescribed epidural analgesia postoperatively. A total of 58 heel observations were made.

RESULTS

Heel damage prevalence in the study sample was 13.8% (n=8).

CONCLUSION

Intrinsic factors associated with this complication included intra- and postoperative hypotension, vascular disease, smoking, chronic obstructive pulmonary disease, and multiple disease burdens. Extrinsic factors associated with heel damage included thromboembolic deterrent stockings and the postoperative ward use of heel protectors designed for use in operating theatres. It is hoped that the study findings will assist improvements in the assessment of heel damage risk and promote the pressure prevention strategies required by this patient cohort.