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To hose or not to hose that is the question...

Authored by: Jennifer Combs, MSN, ARNP, NATF Advocacy Committee

June 5, 2009

Deep venous thrombosis (DVT) is the formation of potentially life threatening blood clots in the deep veins of the body. These clots can occur anywhere, but commonly occur in the legs, arms, and pelvis. Education is the key to prevention when it comes to DVT. Knowing one’s risk factors is the first step to empowering one’s self. Once the risk factors are known, you can take the necessary steps to help reduce your risk. If you know that you are at an increased risk for developing DVT, one of the steps you can consider is the use of a mechanical compression device.

Mechanical compression device? Sounds like you are strapping a piece of machinery to your body. Well, in a sense, you are. Before looking at compression devices, one must first understand why these devices can be a very valuable tool for the person at risk for DVT.

Following a DVT, up to two thirds of survivors go on to develop long-term complications including post-thrombotic syndrome or chronic deep vein insufficiency. Chronic venous insufficiency is impaired venous return, which can cause discomfort in the legs, swelling, and changes in the skin. Post-thrombotic syndrome is symptomatic chronic venous insufficiency that develops after DVT. The key to preventing these conditions is the adequate treatment of DVT and the use of compression stockings. To understand why compression stockings work, one must first understand the physiology of circulating blood.

Venous blood return from the lower extremities relies on the contraction of the lower leg muscles to push blood from the superficial veins into the deep veins. Valves inside the veins help direct blood towards the heart. When one has had a DVT, a venous obstruction may occur when scar tissue develops as the body fights to break down the clot. This scar tissue can lead to damage of the valves in the veins, leading to swelling, pain, and heaviness in the affected extremity. The edema tends to worsen progressively throughout the day because blood must flow upward, working against gravity, when a person is standing or sitting. Sometimes, the veins are completely destroyed, leading to further complications.

When a person has suffered severe damage to a vein, leg or arm edema may always be present. The skin on the affected extremity may become discolored, thickened, scaly, or itchy. These areas of skin are very prone to injury and may develop skin ulcers, which can be very difficult to heal. Mechanical compression devices can play an important role in prevention and treatment of these conditions.

Elastic compression stockings (support hose) may help in some small way but are not sufficient protection against the development of DVT. While the continuous use of elastic hose narrows the veins and makes blood flow more rapidly, many people develop a false sense of security when wearing these elastic stockings and may even disregard other more effective means of DVT prevention. There is a much more effective way to help prevent the development of DVT: pneumatic compression stockings.

Pneumatic compression stockings are plastic stockings that are automatically “pumped up” and “emptied” by an electric pump. There are different sizes and they may extend from the ankle to the knee or thigh. These compression stockings continuously run through a cycle of squeezing the calves, which forces the blood in the veins up towards the heart. It is recommended that these devices be applied to patients undergoing gynecological surgery, orthopedic surgery, or to patients with an identified increased risk of developing DVT. The pneumatic compression stockings should be applied before surgery begins and worn until one is able to ambulate fully. An alternative to the compression stocking is the graduated compression stocking (GCS).

Graduated compression stockings are a compression garment that can be custom fitted to a person who has developed a DVT and is suffering from chronic venous insufficiency or post-thrombotic syndrome. The garment extends from the toes to the knee or thigh. It is tighter at the ankle and progressively decreases in tightness as it extends up the extremity, forcing blood towards the heart and decreasing the amount of swelling and pain in the affected limb.

Mechanical compression devices can literally be lifesavers, but they have to be utilized in order to do be successful. Personally, for this author, as survivor of a DVT and massive pulmonary embolism (PE), I had no knowledge of these valuable tools until it was too late. One month prior to the development of my DVT and PE, I had undergone gynecological surgery, yet I did not know my risk factors and did not know the importance of my physician ordering a mechanical compression device for me during surgery and after. Ignorance is bliss, but can also be deadly.

So to answer the question that we started with: to hose or not to hose? Knowledge of your risk factors, engaging your physician in an open dialogue about your risk factors, and developing a plan of care together with your health care provider can make all the difference. Only you and your healthcare provider can answer that question, but in the end, always remember you only have only life to live, so protect it.

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