anti-embolism stockings (Thrombo Embolus Deterrent (TED) stockings)

Last edited 08/2018

NICE suggest that anti-embolism stockings (TEDs) are a mechanical prophylaxis versus venous thromboembolism.

• anti-embolism stockings should not be offered to patients who have:
  • suspected or proven peripheral arterial disease
  • peripheral arterial bypass grafting
  • peripheral neuropathy or other causes of sensory impairment
  • any local conditions in which stockings may cause damage, for example fragile 'tissue paper' skin, dermatitis, gangrene or recent skin graft
  • known allergy to material of manufacture
  • cardiac failure
  • severe leg oedema or pulmonary oedema from congestive heart failure
  • unusual leg size or shape
  • major limb deformity preventing correct fit
• caution and clinical judgement should be used when applying anti-embolism stockings over venous ulcers or wounds
• patients who need anti-embolism stockings should have their legs measured and that the correct size of stocking is provided. Anti-embolism stockings should be fitted and patients shown how to use them by staff trained in their use
• if patients develop oedema or postoperative swelling then they should have their legs re-measured and anti-embolism stockings refitted
• if arterial disease is suspected, seek expert opinion before fitting anti-embolism stockings
• anti-embolism stockings should be used that provide graduated compression and produce a calf pressure of 14-15 mmHg
• patients should be encouraged to wear their anti-embolism stockings day and night until they no longer have significantly reduced mobility
• anti-embolism stockings should be removed daily for hygiene purposes and to inspect skin condition. In patients with a significant reduction in mobility, poor skin integrity or any sensory loss, inspect the skin two or three times per day, particularly over the heels and bony prominences
• use of anti-embolism stockings should be discontinued if there is marking, blistering or discolouration of the skin, particularly over the heels and bony prominences, or if the patient experiences pain or discomfort. If suitable, offer a foot impulse or intermittent pneumatic compression device as an alternative

Reference:

• 1) NICE (January 2010). Reducing the risk of venous thromboembolism