Medical thrombosis prophylaxis stocking

Medical thrombosis prophylaxis stockings (MTPS) are used in bedridden patients to prevent thrombosis as part of thrombosis prophylaxis . MTPS are compression stockings that are usually put on in the perioperative area , i.e. before, during and after an operation. They remain until the patient is independently mobile again. Alternatively, medical thrombosis prophylaxis stockings are called MT stockings or MTS for short. An outdated name for the MTPS is antithrombosis stocking (ATS).

Thrombosis prophylaxis

A thrombosis of the deep veins in the leg can lead to a pulmonary embolism , one of the most common causes of death , among other serious consequences . Hospitalization increases the risk of developing deep vein thrombosis. Therefore, prophylactic measures are taken in clinics to reduce the risk to patients. This includes the supply of medical thrombosis prophylaxis stockings, which were introduced in Germany during the 1970s and 80s for physical prophylaxis . The application of MTPS is considered a basic measure of physical thrombosis prophylaxis, which can also include movement exercises. In patients with a medium or high risk of thrombosis, intermittent pneumatic compression can complement physical prophylaxis .

Mode of action

Medical thrombosis prophylaxis stockings (MTPS) exert a low compression pressure on the respective leg, which should be a maximum of 21 mmHg , but usually between 13 and 18 mmHg and at least between 5 and 10 mmHg. This pressure reduces the cross-section of the leg veins , which accelerates the venous return of the blood towards the heart . To support the cardiac blood flow, the compression pressure that the MTPS generates decreases towards the heart. In the ankle region , MTPS exert a higher pressure than on the lower leg and here again higher than on the knee or - depending on the length - on the thigh. The reduced vein diameter as a result of the pressure exerted on the leg also enables any dilated venous valves to resume their function as a backflow valve .

Manufacturing, material and variants

Medical thrombosis prophylaxis stockings

Medical thrombosis prophylaxis stockings are seamlessly manufactured in a circular knitting process in knee and thigh-length variants and usually consist of white knitted fabric with elastic fibers incorporated. Materials used in manufacture are polyamide , elastane , polyurethane and polyester . MTPS always have a closed heel and usually an opening below the tip of the foot in order to be able to examine any discoloration of the patient's toes. In contrast to medical compression stockings , for example, there are no binding guidelines for pressure values to be guaranteed by MTPS, a recommended pressure profile on the leg or sizes to be produced. Some manufacturers offer MTPS in up to three or more different sizes for different leg circumferences and lengths. In order for a medical thrombosis prophylaxis stocking to develop its effectiveness, it is necessary to select a model that fits the patient exactly, that fits exactly, does not constrict and lies wrinkle-free. If the fit is too loose, the MTPS has no effect. On the other hand, stockings that are too tight or even constricting can hinder blood circulation. Therefore, the correct fit of an MTPS is regularly checked and any discoloration of the skin of the toe region is observed through the viewing window in the forefoot area.

Status

Experts criticize the fact that the MTPS are often not available in all sizes and shapes in everyday care and that they are therefore often applied as part of the care routine without aiming for a comprehensible effect. An Australian study in 2002 found that doctors were unsure about how to determine a risk of thrombosis, were unable to order suitable prophylactic measures, and their instructions were poorly implemented by the nursing staff. After studies in the mid-2000s also showed that the effect of physical prophylaxis alone through MTPS is very low, while at the same time the risk of injury from skin abrasions increases, the importance of medical thrombosis prophylaxis stockings is currently under scrutiny. A systematic review based on the data from the Cochrane database , a so-called Cochrane Review , found in 2016 that, according to studies, MTPS can reduce the risk of deep vein thrombosis as a result of surgical interventions. Particularly against the background that the state of knowledge on drug prophylaxis has improved significantly since the introduction of MTPS, its usefulness is increasingly being questioned. The current S3 guideline on the prophylaxis of venous thromboembolism provides that MTPS should not be applied as part of physical prophylaxis "in the recommendation corridor" . However, this does not mean that it is always right to do without medical thrombosis prophylaxis stockings. For example, if drug prophylaxis is not possible, there is still a clear indication for MTPS.

literature

Stefanie Reich-Schupke, Markus Stücker: Modern Compression Therapy - A Practical Guide . Viavital Verlag, Cologne 2013, ISBN 978-3-934371-50-7 .

Kerstin Protz, Joachim Dissemond, Knut Kröger: Compression therapy An overview for the practice. Springer Verlag, Berlin a. a. 2016, ISBN 978-3-662-49743-2 .

Web links

S-3 guidelines (for download) of the AWMF for the prophylaxis of venous thromboembolism

Individual evidence

↑ ^a ^b Ina Brandt (Ed.): Care techniques today. 2nd Edition. Elsevier Urban & Fischer Verlag, Munich 2010, ISBN 978-3-437-27091-8 , pp. 376-379.
↑ ^a ^b K. S. Kussmann: Venous diseases. In: Eberhard Rabe (Ed.): Apparative intermittent compression therapy. Viavital Verlag, Cologne 2003, ISBN 3-934371-29-9 , pp. 39-59.
↑ ^a ^b ^c ^d Knut Kröger: Does compression therapy still play a role in thrombosis prophylaxis today? In: Phlebologie 4/2016, pp. 230–232.
^ I Care Care. Thieme Verlag, Stuttgart 2015, ISBN 978-3-13-165651-3 , p. 421.
↑ Hairul Ahmad: Deep venous thrombosis prophylaxis: are guidelines being followed? Australian New Zealand (ANZ) Journal of Surgery, 5/2002, p. 320.
↑ A. Stephan, R. Möhler (trans.): Can MTPS avoid deep vein thrombosis? In: Die Sister Der Pfleger , 55th year, number 4 (2016), ISSN 0340-5303, pp. 86–87.
↑ Silvia Haas, Albrecht Enke, Ina Kopp: S-3 guideline for prophylaxis of venous thromboembolism. In: Deutsche Medizinische Wochenschrift , 7/2016, pp. 453–456.

[Bra-1] Ina Brandt (Ed.): Care techniques today. 2nd Edition. Elsevier Urban & Fischer Verlag, Munich 2010, ISBN 978-3-437-27091-8 , pp. 376-379.

[Kuss-2] K. S. Kussmann: Venous diseases. In: Eberhard Rabe (Ed.): Apparative intermittent compression therapy. Viavital Verlag, Cologne 2003, ISBN 3-934371-29-9 , pp. 39-59.

[KK-3] Knut Kröger: Does compression therapy still play a role in thrombosis prophylaxis today? In: Phlebologie 4/2016, pp. 230–232.

[4] I Care Care. Thieme Verlag, Stuttgart 2015, ISBN 978-3-13-165651-3 , p. 421.

[5] Hairul Ahmad: Deep venous thrombosis prophylaxis: are guidelines being followed? Australian New Zealand (ANZ) Journal of Surgery, 5/2002, p. 320.

[6] A. Stephan, R. Möhler (trans.): Can MTPS avoid deep vein thrombosis? In: Die Sister Der Pfleger , 55th year, number 4 (2016), ISSN 0340-5303, pp. 86–87.

[7] Silvia Haas, Albrecht Enke, Ina Kopp: S-3 guideline for prophylaxis of venous thromboembolism. In: Deutsche Medizinische Wochenschrift , 7/2016, pp. 453–456.