American Academy of Nursing

View all recommendations from this society

April 19, 2018

Don’t routinely use graduated compression stockings in surgical patients as mechanical prophylaxis for preventing venous thromboembolism (VTE) after surgery, but do consider using intermittent pneumatic compression devices.

Thromboembolic disease is a significant cause of complications and mortality in hospitalized patients and a growing public health issue. Although anyone can develop a VTE, research shows that half of the VTE events in the outpatient setting are directly linked to a recent hospitalization. Many of these events can be prevented through pharmacological and/or mechanical VTE prophylaxis. Current guidelines that recommend mechanical devices demonstrate a preference for intermittent pneumatic compression-pc (IPC) devices with no recommendations for graduated compression stockings (GCS), except for women at high risk for VTE after cesarean delivery. These IPC devices minimize adverse effects to skin, promote patient comfort, and permit clinician assessment compared to graduated compression stockings.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a health professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician or nurse.

How The List Was Created

The American Academy of Nursing has convened a Task Force of member fellows who are leaders of professional nursing organizations representing a broad range of clinical expertise, practice settings and patient populations. The Task Force collaboratively identifies nursing/interdisciplinary interventions commonly used in clinical practice that do not contribute to improved patient outcomes or provide high value. An extensive literature search and review of practice guidelines is conducted for each new proposed recommendation for the list. The supporting evidence is then reviewed by the respective nursing organization(s) with the most relevant expertise to each recommendation. The Academy Task Force narrows the recommendations through consensus, based on established criteria. The final recommendations are presented to the American Academy of Nursing’s Board of Directors for approval to be added to the Choosing Wisely list created by the Academy. Once approved by the Academy’s Board of Directors, the recommended statements are sent to the ABIM Foundation for an external review by physician(s) and nurse(s) and final approval for consistency with the ABIM Foundation principles.

Recommendations were developed in partnership with the following organizations: Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), recommendations 1, 11, 12, & 13; Academy’s Expert Panel on Aging, recommendations 2, 3, 14, 15, & 24; American Association of Critical- Care Nurses (AACN), recommendations 4 & 5; Oncology Nursing Society (ONS), recommendations 6, 7, 8, 9, & 10; American Association of Neuroscience Nurses (AANN), recommendations 16, 17, 18, 19, & 20; Academy’s Expert Panel on Acute & Critical Care, recommendation 21; Society of Pediatric Nurses (SPN), recommendation 22; American Pediatric Surgical Nurses Association, Inc. (APSNA), and the American Pediatric Surgical Association (APSA), recommendation 23; and the Association of periOperative Registered Nurses (AORN), American Association of Nurse Anesthetists (AANA), and the American Association of Neuroscience Nurses (AANN), recommendation 25.

The American Academy of Nursing’s conflict of interests and disclosures policy can be found at


Dunn N, Ramos R. Preventing Venous Thromboembolism: The Role of Nursing With Intermittent Pneumatic Compression. Am J Crit Care. 2017 Mar; 26(2):164-167.

Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuünemann HJ; American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel. Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb; 141(2 Suppl):7S-47S.

Kakkos SK, Caprini JA, Geroulakos N, Stansby G, Reddy DJ, Ntouvas I. Combined intermittent compression and pharmacologic prophylaxis for prevention of venous thromboembolism. Cochrane Database of Systematic Review. 2016, Issue 9. No: CD005258.

Qaseem A, Chou R, Humphrey LL, Starkey M, Shekelle P; Clinical Guidelines Committee of the American College of Physicians. Venous thromboembolism prophylaxis in hospitalized patients: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2011 Nov 1;155(9):625-32.

Raskob GE, Silverstein R, Bratzler DW, Heit JA, White RH. Surveillance for deep vein thrombosis and pulmonary embolism: recommendations from a national workshop. Am J Prev Med. 2010 Apr;38 (4 Suppl): S502-9.