Anti-Embolism Stockings Nursing Procedure - Essay Example

Anti-Embolism Stockings Nursing Procedure Anti-Embolism Stockings Nursing Procedure A1 This is one of the nursing procedures applied to prevent further progression and protect people against venous disorders. In this procedure, nurses or any medical assistant dresses the patient’s legs with Anti-Embolism Stockings. Venous disorders are caused by deterioration of the internal walls of leg veins. The small valves become defective and incompetent. When this occurs, blood flows backwards to the foot in a process called reflux. When the superficial veins fail, only the veins in deeper locations of the legs will carry blood to the heart. Since more blood has to flow through the deep veins, it forces the veins to expand and valves to close half way. In severity, the deep veins may also become incompetent. When there is ineffective blood flow to the legs, peripheral veins remain clogged even when walking. These veins remain filled with blood even and pressure therein does not drop; a condition referred to as chronic venous insufficiency (CVI). It may result in ulcers, edema or skin change. In treatment, nurses dress the patient’s legs with Anti-Embolism Stockings. These are close fitted, circular knitted elastic socks designed to be worn by patients exhibiting venous disorders. They were designed to increase the linear velocity of blood by exerting external pressure on the legs. These special socks are designed to prevent thromboembolism by the use of graduated pressure. These special socks are prescribed to patients experiencing blood pooling in the legs, blood clots and lower limb edema due to long hours of sitting. It is recommended that nurses should effectively access the patients’ legs and measure them for the correct size of Anti-Embolism Stockings. Process Nurses need the following things before the socks can be applied: Wall chart, tape measure, T.E.D stocking order pad/sizing chart and package of the covidien T.E.D; the anti-embolism stockings. The nurse is responsible for application, sizing and maintenance of the special stocking. Proper sizing of the Anti-Embolism Stockings is necessary so that the patient can enjoy the maximum benefits of the therapeutically treatment (Miller, 2011). Once the above things are available the following procedure should be followed: 1. Take the measurement of the upper thigh circumference at gluteal furrow and record it as measurement 1, 2. Take the measurements of the calf circumference at greatest measurement and record it as measurement 2 3. Take the measurement of the leg length from gluteal furrow to lower part of the heel and record it as measurement 3 4. Check the packing descriptions to ascertain the right size of stocking. If the left and right legs are measured simultaneously, different sizes should be issued based on the measurement taken In event that thigh circumference is more than 36 inches, take a knee length stocking Incase calf circumference is out of the identified range of the recommended thigh size, stocking based on the recorded Measurement 1, then choose a knee length stocking 5. Put your hand into stocking and move it down to the heel pocket 6. Grasp the center of the heel and pull the pocket until the stocking is inside out 7. Put the stocking in a position over foot and heel. Make sure patient’s heel is in the middle of heel pocket 8. Pull up a few inches of the stocking around the ankle and calf 9. Keep on pulling the socks up the leg until the stitch change of the stocking falls between 1” and 2” below the knee bend. 10. As thigh part of the stocking is rolled up, begin to rotate the stocking inward so that the panel is centered over femoral artery. The Panel should be placed slightly towards the inside of the leg If you are using thigh length stockings with belt, remember that the side panels are located at the hip bone while upper hem rests on the gluteal furrow 11. Smoothen the stocking so as to do away with any wrinkles on the surface 12. Then align the toes in their respective position such that none of the toes is sticking out. 13. Guide the patient on the correct positioning of the stocking to ensure that the patient does not realign the stocking ineffectively. Charting Nurses should record the size, type of stocking and the date applied. They should also record the date of removal Once removed, the changes on the skin should be recorded. Record and report the absence or presence of tenderness on calves, thighs and toes. Nurses should record the condition of the stocking during each inspection. The stockings should be washed after every 3 days to remove any body secretions. No ointment shall be used; instead, talcum powder should be used. Reason for changing this procedure Many times, Anti-Embolism Stockings may be issued to patients without proper analysis and assessment of other conditions that be generated due to the therapeutically use of the Anti-Embolism Stockings. The Anti-Embolism Stockings may be effective in regulating the flow of blood to legs but may also lead to further complication on the limbs. For instance, id applied to a patient with peripheral arterial disorders, external pressure caused by Anti-Embolism Stockings may further reduce the blood flow to the lower limb. This may result in further disorders such as ischaemia or necrosis of tissue. If the nurses fail to notice the color of the foot, feel the warmth and the palpable pedal pulse, then Anti-Embolism Stockings will be infective in treatment of the pre-diagnosed condition. Anti-Embolism Stockings cannot be prescribed to patients with a stroke. In such cases, nurses and clinicians should always refer to the RCHT guidelines on stroke assessment and treatment. For patients diagnosed with non-haemorrhagic stroke with an increased risk of VTE pharmacological prophylaxis with LMWH should be taken into consideration. The Anti-Embolism Stockings should not be applied to patients with severe or extreme deformity of the leg. Any other leg or skin condition that might worsen or develop due to application of Anti-Embolism Stockings should be identified prior to the application. Failure to notice such underlying issues will result defective side effects of applying Anti-Embolism Stockings. Other researchers have found the stockings ineffective in some cases. They indicate that wrong application may be detrimental to the patients. According to (Macintyre, Kent& McPhee, 2013), those people with circulatory disorders might be required to wear specific stockings or tight-fitting hosiery to offer a compression force to the outer limbs` surface (particularly the lower portion) as well as the feet to lessen excess edema. The powerfully elastic nature of the stockings that provides the needed compressive force for the therapeutic advantage of the stockings makes the stockings hard to don. Application of these stockings is always further complicated by the lack of flexibility or strength of the wearer resulting from the general physical condition (effects of aging, sciatica, lumbago, arthritic ailments, and congestive heart failure included) or the latest injury or surgery (like knee, foot or hip arthroplasty, and the surgeries that entails cardiovascular or even pulmonary systems) resulting tothe need of using elastic stockings. Despite the widespread applications and reported efficacy of the anti-embolic stockings, some researchers have established contrary results. According to these scientists, some of the commercially produced stocking have led to worsening patient conditions after application. Also wrong prescriptions have had similar results leading to worsening of patient situations and even death. Wrong quality of anti-embolic stockings were observed to reverse the pressure conditions and therefore leading to ineffectiveness of the therapy (Autar, 2009). A2a. The invention and use of Anti-Embolism Stockings can be attributed to a number of research scientists such as Wilkens and Doorenbos. The anti-embolic stockings were firs invented by Barbara L. Basaj back in the early 90s. The adaption of the method into practice has taken a long path due to the staged inventions. Many researchers were responsible for contributing their patched information to the identification and use of the Anti-Embolism Stockings. A2b. In their first encounter, they thought the socks could be applied to anybody as long as they were suffering from deep vein thrombosis. The adoption of this therapeutic method was first done in the US and UK where the venous disorders were highly recorded.it was then adapted to the other parts of the world as it was found to be 50% effective. According to the inventors of this method, every year 25,000 individuals in UK die of venous thromboembolism. Unfortunately, this figure consists of both the patients admitted for a medical care of some serious illnesses and those admitted for the surgery. The moment DVT (Deep vein thrombosis) is developed, it`s a cause of a substantial morbidity and it may cause the development of PTS (post thrombotic syndrome) with clinical elements of chronic swelling as well as ulceration of the limbs. Used as a prophylactic is the Graduated AES (Anti-embolism compression stocking). This is a measure to thwart deep vein thrombosis as well as pulmonary emboli among the patients at risk (Ohayon, Rose, Ebert, Lewis, Vater & Overby, 2013). When correctly applied, these AESs are safe and non-invasive therapy which works by simply exerting graded circumferential force from distal to the proximal areas of the limbs. A2c. The inventors of this therapy had an objective of reducing deaths that were occurring due to deep vein thrombosis. According to them, the Anti-Embolism Stockings worked effectively in regulating blood pressure in the affected limbs if they were applied according to the issued manual. As described by some of the pioneers of this method, the method was applied because the AEShas two probable actions in thwarting DVT among the immobile patient; the graduated compression enhances the blood flow velocity and also promotes venous return. The inhibition of a passive venous distension, normally, is thought to stop sub- endothelial tears as well as the activation of the clotting factors. However, the adoption of AES never goes without risk, as such it is imperative that patients are effusively assessed and their limbs carefully measured prior to fitting the stockings and that stocking utilization is closely monitored. A4. If this method was changed, it could mean that the alternative therapies in prevention and treatment of Deep Vein Thrombosis (DVT) could be applied. As established during this study, DVT can also be treated by surgical therapy. Surgical therapy was established as a last resort method but it is more effective and less detrimental as compared to the application of anti-embolic stockings. Surgical treatment of DVT is not a method many patients preferred. As revealed by researches, many of the patients chose anti-embolic stockings since they thought that it was effective and less involving as compared to surgery. Therefore a change in treatment mechanism is likely to physically and psychologically affect patients. Other treatment methods available include anticoagulants like warfarin and heparin. These have been found to diverse side effects that may be detrimental to patients. As revealed by research, surgery was established to be more costly than the anti-embolic stockings. This means that patients will have to dig deeper into their pockets to afford surgical treatment. A5. A change in the treatment method is likely to impact the nursing practice, though insignificantly. If the anti-embolic stockings were abolished, it could mean that surgery and anticoagulants could be employed in the treatment of venous disorders. If surgery, for instance was the recommended treatment mechanism, it could be a little involving for nurses. Some of the nurses that were involved in administering the anti-embolic stockings therapy could be relieved off their duty and thus give them more time to focus on other patient care areas. A6. Stake holders attributed to this study include: doctors, nurses, patients, medical regulatory boards, the government and the general public. Once this report is completed, the stake holders will be handed a copy of the findings and recommendations. A stakeholder awareness campaign will be conducted so as to help them understand the report. Consultation will also be done among the stake holders to ascertain their stand with regard to the findings and recommendations. It will be prudent to not their reactions to the suggestions. Some of the stakeholders, for instance doctors and nurses, may have opposing views to this study and others may have contributory remarks, it will be important to note them and if possible try and accommodate such into the final implementation schedule. B1 Implementing research findings may not be easy if the research itself is not backed with sufficient evidence. For instance, if the commonly used method of treatment is backed with high success rates, it will be difficult to convince stakeholder that the new proposed methodology is more efficient that what they have tangible evidence about. It will be of need to carry out more investigations and back up this study with more evidence so as the research implementation will be undertaken with ease. Another problem associated with implementing research findings is the reluctance of stakeholders in adapting the recommended treatment methods. A research may be backed with the necessary evidences required but some of the stake holders may not be willing to leave the discarded method because of the attachment and specialization that has acquired (Patel, Khakha & Gibbs, 2013). Incorporating the government and other medical regulatory bodies will help in coming up with rules and regulations that will smoothen the translation and adaption of the research findings. B2 There may be opposition from the stakeholders regarding the findings and recommendations of this study. The doctors and nurses, for instance may challenge the abolition of the stockings based on their medical experience. The general public may also object the subjection to surgery and anticoagulants which they may think are a little expensive compared to the anti-embolic stockings. Medical regulatory authorities may also object the use anticoagulants due to their detrimental side-effects. Surgery may be a little tricky compared to the anti-embolic stockings. Some of these issues might arise during adaption of this study’s recommendations. Another problem is likely to arise from the patients currently undertaking the stockings therapy and those that have successfully cured DVT using this therapy. It could be difficult to convince someone who was cured through the therapy that it is ineffective. It will also be difficult to convince those under anti-embolic stockings therapy that they should abandon the therapy for anticoagulants or surgery. Some may accept while other may reject it owing to the success they perceive and the ease in therapy administration associated with anti-embolic stockings. Some patients may develop fear if they hear that they will undergo surgery instead of the easy method they have known. B3 As mentioned earlier, awareness is necessary before the recommendations are implemented. Awareness will involve demonstration and synthesizing the various stakeholders into the adaption of the new findings. It will be important to obtain their views about the while research and its finding so as to change the recommendations if necessary. Their views may also be important in ascertaining the difficulties likely to be encountered during implementations. These will help the researchers in hedging the difficulties in earlier stages. B4. The first implementation stage of this research will be accreditation by the relevant authorities. If the research is acceptable, it will be recognized by the government and regulatory bodies and documented. The old treatment method will be rendered ineffective or discouraged by the regulatory bodies. Once this is done, the clinicians and other medical personnel will have no option but adapt to it. References Autar, R. (2009). A Review of the Evidence for the Efficacy of Anti-Embolism Stockings (AES) In Venous Thromboembolism (VTE) Prevention. Journal of Orthopaedic Nursing (J ORTHOP NURS), 13 (1): 41-9. Macintyre, L., Kent, K., & McPhee, D. (2013). Do Anti-Embolism Stockings Fit Our Legs? Leg Survey and Data Analysis. International Journal of Nursing Studies (INT J NURS STUD), 50 (7): 914-23. Miller, J. A. (2011). Use and Wear Of Anti-Embolism Stockings: A Clinical Audit of Surgical Patients. International Wound Journal (INT WOUND J), 8 (1): 74-83. Ohayon, R., Rose, R., Ebert, K., Lewis, C, Vater, M., & Overby, V. (2013). Incidence of Incorrectly Sized Graduated Compression Stockings and Lower Leg Skin Irregularities In Postoperative Orthopedic Patients.MEDSURG Nursing (MEDSURG NURS), 22 (6): 370-4. Patel N., Khakha, R., & Gibbs, J. (2013). Review article: Anti-embolism Stockings.Journal Of Orthopaedic Surgery (Hong Kong), 21 (3), pp. 361-4. Read More