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Which Graduated Compression Stocking?

One of the successes of consumers' associations in the UK and elsewhere has been to draw attention to the very real differences that exist in the performance and quality of products. To a large extent publications like " Which? " introduced the concept of evidence-based purchasing to everyday life. It has been very successful - and perhaps one of the main reasons why cars, for instance, do not now rust through in just a few years.

There are probably examples in health care - but they are not always so obvious, which just increase the pleasure when one appears.

Report

Stephen Thomas of the Surgical Materials Testing Laboratory at Bridgend General Hospital has sent Bandolier a copy of a report produced in 1992 on graduated compression stockings. It makes gripping reading.

The report contains a comparison of the compression profiles produced by 10 brands of elasticated stockings intended for the prevention of deep vein thrombosis (DVT) in non-ambulant patients. While there was not, in 1992, a formal specification for compression stockings in bedridden patients the principles of some appropriate British Standards were applied.

British Standard leg

There are five 'standard legs'. Thigh-length stockings were tested using sizes appropriate to each of the standard legs, again using appropriate British Standard methods, before and after washing by British Standard methods. The average pressures exerted at the ankle, calf, knee and upper and lower thigh positions were compared with values recommended in the literature.

Recommendations

In order to exert an optimal clinical effect a stocking designed to prevent an embolic event in a patient confined to bed should meet the following design and performance criteria:-
  • Produce graduated compression decreasing from ankle to knee
  • Calf pressure should be about 15 mmHg
  • All sizes should produce consistent compression profiles in appropriate sized legs
  • There should be no tourniquet effect at the top
  • Available in a large range of sizes
  • There should be little variation in pressure produced when applied to legs slightly different from "standard"
  • Pressures produced should remain unaffected by washing
  • Minimum information should be printed on the stocking

Results

None of the stockings tested in 1992 met all of these conditions. Two brands were closest. They were TX (from Brevet) and Thrombex (from Seton). The performance of others varied, but several performed so badly that the were considered of questionable value or even potentially hazardous in some circumstances.

Literature review

The report comes with a very useful and thorough literature review and history of the development of graduated compression stockings. It is an exemplar of what we need to see to make evidence-based purchasing effective in the NHS.

Reference:

S Thomas. Graduated external compression and the prevention of deep vein thrombosis. 1992 ISBN 1 874517 00 2.

Dr S Thomas, SMTL, Bridgend General Hospital, Quarella Road, Bridgend,
Mid-Glamorgan CF31 1JP.
Tel: 01656 652166.



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