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TED hose (compression stocking)

Elastic stocking (hose) that provide compression the lower extremities. Above & below the knee stockings are available. Indications: 1) adjunctive management of lower extremity edema 2) adjunctive treatment in prevention of vasovagal reaction [11] 4) adjunctive management for prevention of deep-vein thrombosis (DVT) a) often used in connection with synchronized compression devices (SCD) b) thigh length compression stockings more effective inpreventing DVT than below the knee compression stockings [2,3] c) neither thigh length nor below the knee length stockings very helpful in preventing symptomatic proximal DVT or pulmonary embolism [3] 3) may reduce recurrence of venous leg ulcers [5] Contraindications: - wounds that would preclude their use - compression stockings do not reduce the risk for deep venous thrombosis after stroke [2,8] - compression stockings do not reduce the risk for post-thrombotic syndrome after DVT [4] - post-surgical prophylaxis for venous thromboembolism [10] Benefit/risk: - do not use compression stockings for prophylaxis [6,10] - skin damgage cited as harm [6] - graduated compression stockings for post surgical patients - number needed to treat to prevent 1 DVT = 7-9 [7] - unknown number harmed from discomfort [7] - effective in diminishing risk of DVT in hospitalised patients [8] - more effective when used with another method of DVT prophylaxis [8] - effectiveness of graduated compression stockings for hospitalized medical patients is uncertain [7] - no benefit after stroke [2,9] Complications: - skin breakdown (2.9% below the knee, 3.9% thigh-high) [3] Notes: - 20-30 mm Hg compression is standard. - ankle pressure 30-40 mm Hg for DVT TEDs (terrible elastic devices) Veterans administration: 1) Order under prosthetics 2) Select stockings in prosthetics menu 3) VA carries below knee stocking only

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stocking

References

  1. Veteran's Administration, Delacruz, P
  2. The CLOTS Trials Collaboration Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): a multicentre, randomised controlled trial The Lancet, Early Online Publication, 27 May 2009 doi:10.1016/S0140-6736(09)60941-7 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60941-7/abstract
  3. The CLOTS (Clots in Legs Or sTockings after Stroke) Trial Collaboration* Thigh-Length Versus Below-Knee Stockings for Deep Venous Thrombosis Prophylaxis After Stroke. A Randomized Trial. Ann Intern Med. 2010 Nov 2;153(9):553-62. Epub 2010 Sep 20. PMID: 20855784 http://www.annals.org/content/early/2010/09/20/0003-4819-153-9-201011020-00280.full
  4. Kahn SR et al. Compression stockings to prevent post-thrombotic syndrome: A randomised placebo-controlled trial. Lancet 2013 Dec 6 PMID: 24315521 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61902-9/fulltext
  5. Ashby RL et al. Clinical and cost-effectiveness of compression hosiery versus compression bandages in treatment of venous leg ulcers (Venous leg Ulcer Study IV, VenUS IV): A randomised controlled trial. Lancet 2013 Dec 6 PMID: 24315520 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62368-5/fulltext
  6. Lederle FA et al Venous Thromboembolism Prophylaxis in Hospitalized Medical Patients and Those With Stroke: A Background Review for an American College of Physicians Clinical Practice Guideline Annals of Internal Medicine November 1, 2011 155(9):602-615 PMID: 22041949 http://www.annals.org/content/155/9/602.abstract corresponding NGC guideline withdrawn Nov 2016 - Qaseem A et al Venous Thromboembolism Prophylaxis in Hospitalized Patients: A Clinical Practice Guideline From the American College of Physicians Annals of Internal Medicine November 1, 2011 155(9):625-682 http://www.annals.org/content/155/9/625.full.pdf+html corresponding NGC guideline withdrawn Nov 2016
  7. The NNT: Elastic Stockings for Deep Vein Thrombosis Prevention After Surgery. http://www.thennt.com/nnt/elastic-stockings-for-deep-vein-thrombosis-prevention-after-surgery/ - The NNT: Elastic Stockings Plus Medical Therapy for Deep Vein Thrombosis Prevention After Surgery. http://www.thennt.com/nnt/elastic-stockings-plus-medical-therapy-for-deep-vein-thrombosis-prevention-after-surgery/ - Sachdeva A, Dalton M, Amaragiri SV, Lees T. Graduated compression stockings for prevention of deep vein thrombosis. Cochrane Database Syst Rev. 2014 Dec 17;12:CD001484. Review. PMID: 25517473
  8. The NNT: Elastic Stockings Plus Medical Therapy for Deep Vein Thrombosis Prevention After Surgery http://www.thennt.com/nnt/elastic-stockings-plus-medical-therapy-for-deep-vein-thrombosis-prevention-after-surgery/ - Sachdeva A, Dalton M, Amaragiri SV, Lees T. Elastic compression stockings for prevention of deep vein thrombosis. Cochrane Database Syst Rev. 2010 Jul 7;(7):CD001484. PMID: 20614425
  9. The NNT: Graduated Compression Stockings for Prevention of Deep Vein Thrombosis in Stroke Patients - Naccarato M, Chiodo Grandi F, Dennis M, Sandercock PA. Physical methods for preventing deep vein thrombosis in stroke. Cochrane Database Syst Rev. 2010 Aug 4;(8):CD001922 PMID: 20687069
  10. American Academy of Nursing Twenty-Five Things Nurses and Patients Should Question Choosing Wisely. An initiative of the ABIM Foundation Released April 19, 2018 (21-25) http://www.choosingwisely.org/societies/american-academy-of-nursing/
  11. Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019