Safe Patient Handling
Applying Elastic Stockings
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- » Transferring from a Bed to a Stretcher
- » Performing Passive Range-of-Motion Exercises
- » Applying Elastic Stockings
- » Assisting with Ambulation Using a Gait Belt
- » Using a Sequential Compression Device
- » Using a Hydraulic Lift
Take the Review Test:
Safety
- Prepare the patient by making sure he or she is rested and not fatigued.
- Determine the type and frequency of application of the elastic stockings.
- Know the patient’s home care plan. The patient may need to continue using the elastic stockings at home.
- Assess the patient for risk factors in Virchow’s triad before applying the elastic stockings.
- Observe for contraindications to the use of elastic stockings, including the following:
- Dermatitis or open skin lesions
- Recent skin graft to the lower legs
- Decreased arterial circulation in the lower extremities, as evidenced by cyanotic, cool extremities and/or gangrenous conditions affecting the lower limb(s)
- Assess the condition of the patient’s skin and circulation to the legs by checking skin temperature and checking for the presence of pedal pulses, edema, discoloration of the skin, and lesions.
- Obtain the health care provider’s order for the use of elastic stockings.
- Use a tape measure to measure the patient’s legs to determine the proper elastic stocking size.
- Remove the elastic stockings at least once per shift, or long enough to inspect the skin for irritation or areas of breakdown.
- Do not use powder or cornstarch to dust the patient’s legs before applying elastic stockings if the patient is sensitive to them.
Equipment
(Roll cursor over items to see labels)
Medical measuring tape
Powder or cornstarch (optional)
Elastic support stockings
Notepad and pencil
PrintableDelegation
The skill of applying elastic stockings can be delegated to nursing assistive personnel (NAP) after the nurse initially determines the size of elastic stockings and assesses the patient’s lower extremities for signs and symptoms of deep vein thrombosis (DVT) or impaired circulation.
Be sure to inform the NAP of the following:
- Report to the nurse immediately if one calf appears larger than the other, or if it is red but not hot. Also report any signs of allergic reactions (redness, itching, irritation).
Preparation
- Assess the patient for risk factors in Virchow’s triad. Risk assessment for deep vein thrombosis (DVT) is crucial to prevent this complication. Use of elastic stockings helps reduce two of the factors in Virchow’s triad.
- Hypercoagulability, such as that related to clotting disorders, fever, or dehydration
- Venous wall abnormalities, such as those related to orthopedic surgery, varicose veins, or atherosclerosis
- Blood stasis, such as that related to immobility, obesity, or pregnancy
- Observe for contraindications to the use of elastic stockings, including the following:
- Dermatitis or open skin lesions
- Recent skin graft to the lower legs
- Decreased arterial circulation in the patient’s lower extremities, as evidenced by cyanotic, cool extremities and/or gangrenous conditions affecting the lower limb(s)
- Assess the condition of the patient’s skin and circulation to the legs by checking skin temperature and for the presence of pedal pulses, edema, discoloration of the skin, or lesions.
- Obtain the health care provider’s order for the use of elastic stockings.
- Perform hand hygiene.
- Identify the patient using at least two patient identifiers, such as the patient’s name and birth date or name and account number, according to agency policy. Compare identifiers with information on the patient’s identification bracelet.
- Explain the procedure to the patient and the reason for applying elastic stockings.
Follow-up
- Instruct the patient not to roll the socks partially down.
- Remove the elastic stockings at least once per shift, or long enough to inspect the skin for irritation or areas of breakdown. Change the stockings daily.
Documentation
- Record the date and time elastic stockings were applied, the skin condition and circulatory status of the legs before application, and the length and size of the elastic stockings.
- Document the time at which the elastic stockings were removed, as well as the skin condition and circulatory status of the legs after removal.
- Record and immediately report signs of thrombophlebitis or impeded circulation to the charge nurse or physician.
- Document your instructions to the patient and family about elastic stocking use and care.
Review Questions
1. When preparing to apply elastic stockings, why does the nurse assess for skin discoloration?
To identify the potential risk for deep vein thrombosis (DVT)
To identify improper patient positioning- To select the proper stocking size
- To determine whether a sequential compression device is needed
CORRECT. The nurse assesses for skin discoloration because it is one possible indicator of deep vein thrombosis (DVT).
INCORRECT. Improper patient positioning is not a rationale for why the nurse assesses for skin discoloration.
INCORRECT. The selection of proper stocking size would be done after the nurse assesses for skin discoloration.
INCORRECT. Determining whether the use of a sequential compression device is needed is not why the nurse assesses for skin discoloration.
2. Which condition is not associated with venous stasis, part of Virchow’s triad?
INCORRECT. Pregnancy, obesity, and immobility can all cause pooling of blood in the lower extremities.
INCORRECT. Pregnancy, obesity, and immobility can all cause pooling of blood in the lower extremities.
CORRECT. Pregnancy, obesity, and immobility can all cause pooling of blood in the lower extremities. Anxiety is not associated with blood stasis.
INCORRECT. Pregnancy, obesity, and immobility can all cause pooling of blood in the lower extremities.
3. Why does the nurse remove the patient’s elastic stockings at least once per shift?
- To permit the skin to breathe.
- To wash the legs with a disposable bath product.
- To air out the stockings and allow sweat to evaporate.
- To check the skin for irritation or breakdown.
INCORRECT. Although proper skin care is important, the nurse does not remove the elastic stockings once per shift to permit the skin to breathe.
INCORRECT. The legs do not need to be washed once every shift.
INCORRECT. Although proper care to the skin is important, the elastic stockings are not removed every shift to allow the sweat to evaporate.
CORRECT. The nurse removes the patient’s elastic stockings at least once per shift to check the skin for irritation or breakdown.
4. Why might the nurse choose not to apply a pair of prescribed elastic stockings to a patient’s legs?
- The patient will have a scheduled bath in a few hours.
- The patient says they are too tight.
- The patient’s skin is irritated.
- The patient has become fully ambulatory.
INCORRECT. A scheduled bath would not be a reason to postpone application of the stockings.
INCORRECT. The patient is likely to find them uncomfortable, but careful measurement of the legs ensures that he or she is given the proper size.
CORRECT. Elastic stockings should not be applied if the skin of the legs is irritated.
INCORRECT. Incompetent venous values or decreased venous circulation may necessitate the need for elastic stockings even though the patient is fully ambulatory.
5. After determining the proper size stocking and assessing the patient’s circulatory status, a nurse delegates the application of elastic stockings to nursing assistive personnel (NAP). The nurse discovers that the NAP has been using moisturizer on the patient’s legs before applying the stockings. What is the best action by the nurse?
- Explain that moisturizer may cause excessive skin softening, which can lead to skin breakdown.
- Instruct NAP to use a small amount of cornstarch or powder.
- Ask the patient if she is allergic to the moisturizer.
- Inspect the patient’s skin for color variations.
INCORRECT. A moisturizer applied to the legs may not cause skin breakdown, but putting it on the patient’s skin just before applying elastic stockings will make them harder to apply.
CORRECT. Using a small amount of cornstarch or powder will decrease friction and make the stockings easier to apply.
INCORRECT. Sensitivity to moisturizer may cause skin breakdown. An allergy to the moisturizer should have been identified before the moisturizer was applied to the legs.
INCORRECT. Skin color variations are not related to the use of moisturizers before applying elastic stockings. Skin color variations are associated with changes in peripheral circulation, or pathologic conditions. The nurse should have inspected the skin for color variations prior to delegating the application of elastic stockings.
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