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Thigh-High Versus Knee-High

Conquest - Summer 2011

Compression stocking change guards against VTE


By Julie A. Penne

Mary Cline, advanced practice nurse (left), and Cristina
Zita, clinical nurse, measures a patient's leg to ensure
she gets the proper compression stocking to prevent
venous thromboembolisms.
Photo: John Everett

When it comes to compression stockings, less can be more.

That’s what Cristina Zita and her team found this past year when they questioned and researched the use of thigh-high compression stockings over the more comfortable and cost-effective knee-highs.

After a year of research and working through the operational and policy channels, knee-high compression stockings now are the standard of care for MD Anderson’s non-surgical adult patients in the hospital.

In addition, nurses are better educated on the proper sizing, measurement and application of the snug-fitting stockings.

Zita and her team started the project last year after making simple observations in her unit: Thigh-high compression stockings often slipped down the patient’s leg to the knee. If the stockings weren’t comfortable or didn’t fit properly, patients weren’t wearing them.

Preventing VTE is serious business

She and her colleagues knew that if patients weren’t wearing the compression stockings, they were at increased risk for venous thromboembolism (VTE), a potentially life-threatening circulatory condition common to cancer patients.

“So often, we would see a patient with compression stockings that had rolled down and produced a tourniquet effect or that had been removed completely,” Zita says. “Either of those situations could have been dangerous for the patient.”

As one of MD Anderson’s nursing rising stars, Zita elected to take on this question as part of her research component in the year-long clinical nursing leadership development program.

When the extensive literature review was completed, the project advanced for further study and action with a multidisciplinary Professional Action Coordinating Team (PACT), as assigned by MD Anderson’s Nursing Practice Congress.

Switching the primary choice to knee-highs

Zita chaired the PACT, with her mentor, Advanced Practice Nurse Mary Cline, as co-chair. The group recommended early this year that the primary choice for the compression hose on the VTE institutional order set be knee-high length.

The recommendation was approved by a series of institutional clinical leadership committees.

Since the adjustment in standard and the new choice on the institutional order set, updated educational materials and patient and nurse trainings have complemented the change.

In the coming months, the group will submit a paper on their findings and add to the collection of literature they once reviewed on the topic.

“An evidence-based project like this makes you feel you’ve improved care for patients not only at MD Anderson, but also at hospitals all over the world. This process gives nurses a voice, and you contribute that much more to patient care but in a very different way,” Zita says.


© 2014 The University of Texas MD Anderson Cancer Center