Nurs 611 Pico Paper

Graduated Compression Stockings and DVT Prophylaxis

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Sarah Lincoln
NURS 611
December 5, 2013
PICO Paper

In Hospitalized Patients, Do Graduated Compression Stockings Prevent DVT Better
Than No Devices?
Patients in the hospital who are on bed rest are at increased risk for clotting in
their legs. This is due to immobility and the lack of muscle contraction, which decreases
blood flow back to the heart. Graduated compression stockings (GCS) are hosiery-
designed stockings used to decrease the prevalence of a deep venous thrombosis (DVT)
in those at risk. If left untreated, DVT can lead to pulmonary emboli, clots in the
pulmonary artery, which in serious cases can lead to death. Prevention of developing
DVT with the use of GCS is an essential nursing intervention in order to decrease
patient’s risk of clot formation and should be considered in all patients who are at risk,
unless contraindicated.
The stockings are worn by patients on their lower extremities covering their foot
up to, or just above their knee. The stockings are used in order to prevent swelling and to
prevent blood from clotting in the deep veins. The stockings gently squeeze the lower
extremities in order to keep the blood flowing upwards, preventing venous stasis.
Venous stasis, along with anticoagulation defects and trauma to the vessel wall are major
risk factors for developing DVT. Evidence based nursing practice is essential in guiding
interventions that are used. Current evidence supports the importance of the use of
Graduated Compression Stockings and DVT Prophylaxis

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prophylactic interventions such as GCS, in the prevention of DVT and pulmonary emboli
in patients.
While researching the evidence and studies regarding the use of graduated
compression stockings, MEDline, the Cochrane Database of Systematic Reviews,
Evidence Based Nursing, CINAHL, and Nursing Standard were used. Other search
engines included Google Scholar and WebMD for basic information regarding the use
and facts related to graduated compression stockings. Keywords used in the search of
these databases included, “compression stockings”, “DVT”, “prophylaxis” “patients”
“hospitalized”. These key words were searched both with each other and individually in
order to get the most efficient results. It was important to limit the search findings so that
only English language studies appeared, along with the Linked Full Text so that the entire
manuscript was available.
Multiple studies supported the fact that graduated compression stockings were an
effective intervention to decrease the risk of DVT in hospitalized patients. In the
Cochrane Central Register of Controlled Trials (CENTRAL), “Elastic Compression
Stockings for Prevention of DVT Review”, 18 randomized control trials were reviewed
in order to evaluate this topic. There were 1279 analytic units studied in which 662 of the
patients wore compression stockings and 617 did not. Patients who wore the compression
stockings from day one post-op to the day of their discharge, only 86 developed DVT
versus 161 patients who did not wear the stockings and developed one. In this review it
is evident that significant use of GCS in hospitalized patients is essential in the
prevention of DVT. Cochrane Review is reliable because the sample is very large;
therefore it is plausible that it relates to many more populations. As stated in the article,
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“This sample size provides robust evidence to advocate the use of GCS in the clinical
setting, especially amongst surgical patients since most of these patients underwent either
general surgical or orthopaedic surgical procedures”.
Another randomized control trial was performed in a similar review called
“Review: Graduated Compression Stockings Prevent Deep Venous Thrombosis in
Patients Who are in the Hospital” by the Cochrane Database of Systematic Review. In
this review, 1205 patients were studied and the findings explained that of the people who
wore the stockings, 12.3% got a DVT, whereas the patients who did not wear the
stockings had a percentage of 26.5%. The higher percentage of people getting DVT is
evidently due to the lack of the prophylactic intervention of the compression stockings
used.
The use of GCS to prevent DVT is an essential intervention. Another equally
important intervention is the patient education regarding the correct way to wear these
stockings. The article, “Graduated Compression Stockings to Prevent Deep Vein
Thrombosis” by Nursing Standard on CINAHL explained, “Stockings should be the
appropriate size so they are smooth fitting and free from wrinkles, which can restrict
blood flow by acting as a tourniquet.” This article mentioned not only the importance of
the use of the stockings, but also teaching patients the correct way to wear them.
The effectiveness of GCS in patients who are immobile or recovering from
surgery at the hospital is a crucial intervention in order to decrease the formation of DVT
and eventually a pulmonary embolism. The research suggests that comparing patients
who wear them against patients who do not, prove this statement. Randomized control
trials have provided evidence-based information that compression stockings are effective
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devices. For patients who are at a higher risk for blood clot formation (ex. Patients with
pre-existing hypercoagulation disorders, etc.), more measures to prevent clots may be
necessary, including pharmacological methods of prophylaxis. However, according to
current research, patients who are at low risk, including those who are recovering from
surgical procedures, the GCS have been proven to be effective.
There is a great deal of evidence that support the use of GCS in patients
recovering in the hospital. Implications for nursing practice refer to the need of nurses to
assess the patient’s risk level and use appropriate measures according to their
assessments. Patients may require more than the GCS, for example anticoagulant
therapy, in order to successfully reduce a their risk. Patient education, along with health
care professional knowledge is essential when providing care with GCS.
Although the research described above provides sufficient evidence that GCS are
effective in lowering the risk of DVT in hospitalized patients, there are many questions to
be answered with additional research. It would be interesting to explore the length of time
compression stockings should be worn in the hospital and at home to prevent DVT
formation. Evaluation of patient compliance at home would also be of interest in future
research studies.






Graduated Compression Stockings and DVT Prophylaxis

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References
Campbell, S. (2001). Review: Graduated compression stockings prevent deep venous
thrombosis in patients who are in hospital... commentary on amarigiri S, lees TA.
elastic compression stockings for prevention of deep vein thrombosis. cochrane
database syst rev 2000;(3):CD001484 (latest version 8 nov 1999). Evidence Based
Nursing, 4(1), 20-20. Retrieved from
http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=2001044779&s
ite=ehost-live
Sachdeva, A. (2010). Elastic compression stockings for prevention of deep vein
thrombosis. Cochrane Database of Systematic Reviews, (7) Retrieved from
http://search.ebscohost.com/login.aspx?direct=true&db=chh&AN=CD001484&site
=ehost-live
Walker, L., & Lamont, S. (2008). Graduated compression stockings to prevent deep vein
thrombosis. Nursing Standard, 22(40), 35-38. Retrieved from
http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=2009960364&
site=ehost-live