Archway Healthcare Library

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Archway Healthcare Library

• Critically Appraised Topic (CAT)
• Compression stockings and the prevention of DVT
• Richard Peacock

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Archway Healthcare Library

• NHS and academic partners
• Whittington Hospital
• Key relationships, including lead research nurse
• CAT scheme

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Archway Healthcare Library

• Critically Appraised Topics applying evidence
  in the consideration of specific clinical
  questions
• Evidence based medicine is the conscientious,
  explicit, and judicious use of current best
  evidence in making decisions about the care of
  individual patients. The practice of evidence
  based medicine means integrating individual
  clinical expertise with the best available
  external clinical evidence... (Sackett, 1996)

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Archway Healthcare Library

• What is the evidence around the length of
  compression stocking and the prevention of DVT?
• Drivers
• Quality of patient care
• Varying practice across Trust
• Cost factors

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Archway Healthcare Library

• Factors to consider
• Clinical evidence (what prevents DVT better?)
• Compliance
• Adverse events

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Archway Healthcare Library

• Bottom line as of 2004
• Although there is no unequivocal evidence that
  knee length stockings are as effective as thigh
  length stockings at reducing DVT, the research
  indicates that this may be the case. Comfort,
  compliance, correct application and patient
  tolerance should be considered in favour of below
  knee stockings.
• Thigh length stockings may actually cause harm
  due to their tendency to roll down below the knee
  and crease around the leg, causing a tourniquet
  effect that may lead to ischemic limbs or a
  dangerous increase in pressure.
• Below knee stockings are cheaper, easier to apply
  and patients are more likely to comply.

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Archway Healthcare Library

• Recommendations of the CAT are implemented by the
  Trust
• Saving estimated for the Trust of 90,000 pa

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Archway Healthcare Library

• Since CAT produced in 2004, 3 key documents have
  appeared
• RCT - Howard, A. (2004) Randomised clinical trial
  of low weight molecular heparin with thigh-length
  or knee-length antiembolism stockings for
  patients undergoing surgery British Journal of
  Surgery
• NICE Guideline CG46 on Venous Thromboembolism
  2007 - thigh length stockings are preferred to
  knee length because there is evidence that they
  are more effective, but they do recognise that
  there may be occasions when they are not
  suitable, due to fit or patient comfort. In such
  cases knee length stockings should be used as an
  alternative
• Sajid, M.S. et al (2006) Knee versus thigh length
  graduated compression stockings for prevention of
  deep venous thrombosis a systematic review
  European Journal of Vascular and Endovascular
  surgery 32 (not included in NICE guideline)

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Archway Healthcare Library

• Currently under discussion within the Trust,
  within wider context of recommendations of risk
  assessment and DVT.
• Department of Health risk assessment tool vs.
  Autar risk assessment tool.
• Clinical Guidelines Committee meets on 29
  October!