Gradient, or graduated stockings are designed to remedy impaired “Musculovenous pump” performance caused by incompetent leg vein valves. Doctors will typically recommend gradient compression stockings for those who are immobile or inactive for long periods of time, and are prone to blood clotting or blood and fluid pooling.as well as a myriad of complications such as deep vein thrombosis (DVT), varicose veins, lymphedema, edema and post phlebitic syndrome.
Gradient compression hose compress the surface veins, which keeps their diameter small, while simultaneously creating a constant up and down motion on the legs to help drive blood more efficiently back to the heart.
Note: For diabetics with persistent blood and fluid flow complications, they may be instructed by their physicians to wear non-gradient anti-embolism hose, which distributes an equal amount of compression its full length. If the complication(s) cannot be resolved by wearing anti-embolism hose, then a Sequential Compression Device may be recommended for use daily until the condition clears and circulation is returned to normal.
A common indicator for the prescription of such stockings is chronic peripheral venous insufficiency, caused by incompetent perforator veins. Low pressure compression stockings are available without prescription in most countries, and may be purchased at a pharmacy or medical supply store. Stockings with a higher pressure gradient, say, above 25-30mmHg, may require a prescription from a doctor.
It is crucial that compression stockings are properly sized. The compression should gradually reduce from the highest compression at the smallest part of the ankle, until a 70% reduction of pressure just below the knee. Vascular doctors & nurses may use special pads to ensure uniform higher pressure around the circumference of the ankle (to smooth out the irregular cross-sectional profile.) If your doctor does recommend that you wear special pressure stockings make sure that the ones you purchase fit properly as wearing the wrong size or using them incorrectly could keep an existing ulcer from healing properly.
Self-prescription is reasonably safe assuming that the compression gradient is 15-20 mmHg, the ABI (for both legs) is >1.0 and that the stockings fit correctly. “Firm” gradient stockings (20-30 mmHg and 30-40 mmHg) should generally be worn only on medical advice. Although current research reports mixed results of compression socks on athletic performance, there is anecdotal evidence from athletes that they can benefit from such stockings.
Gradient compression hosiery are available in three different lengths: knee-high, thigh length, and over the waist maternity pantyhose and their compression levels (mmHg) range from mild (8-15 mmHg) to firm (30-40 mmHg, which only be worn with the recommendation of a physician or health care provider.)
Over 500,000 people in the United States experience foot and leg ulcers (sores) every year. Based on your leg ulcer concerns, the safest approach to wearing the right type of compression stockings is to first talk with your doctor to get a more informed opinion
How long should compression stockings be worn?
The stockings should be worn daily as long as patient is at increased risk of forming blood clots in the leg and removed at night. For those with varicose veins, venous ulcers and lymphedema, the stockings must be worn for years and in some cases, for life.
It is highly recommended that, whenever possible, individuals keep their legs elevated at night when not wearing compression stockings.
What is the highest compression for non-prescription compression stockings:
Only the lowest compression stockings are available without a prescription. Over-the-counter compression stockings are usually available up to 35mmHg. Any higher pressure requires a prescription to include those that are custom-made. Jobst compression stockings are the most commonly purchased.
Are there any complications associated with the use of compression stockings?
Wearing compression stockings for the first time can take some getting used to. Hot weather may occasionally deter individuals from wearing stockings all day.
Some brands of compression stockings are made with latex which can cause an allergic reactions, however, there are several brands on the market comprised of other synthetic materials that will not irritate the skin.
If too much lotion is applied on the legs when donning compression stockings, it can create a barrier between the stocking and the skin. This can cause a constant rubbing and ultimately a blister may form.
Care should taken to get the correct size as any excess material can wrinkle and bind behind the knees, which will also form a blister.
On the plus side with regard to contraindications for use of compression stockings many wearers suffer much less discomfort while wearing compression stockings than they would using sequential compression devices, which delivers intermittent pressure as opposed to graduated pressure on the leg’s venous cavities.
Maternity pantyhose are especially helpful for women during pregnancy as their venous system is subject to twice the normal strain.
The veins have to transport an increased volume of blood and the higher concentration of progesterone can have a negative effect on venous cavities.
Both types should be worn before moving on to sequential compression devices, pharmaceuticals or invasive treatments. It should be noted that neither gradient compression stockings nor non-gradient compression stockings will eliminate varicose veins.
How should compression stockings fit?
If you purchasing compression gradient compression stockings for the first time prior consultation with a physician is highly recommended.
This is due to the necessity of effectively treating the n,medical condition with the correct compression. Compressions stockings should be measured either by a qualified pharmacy or medical supply store specialist or your physician to ensure that you get the proper size and fit.
If you already know your size and trust your own judgment purchase them based on the size chart found on the stocking package (Wearing ill-fitted gradient compressions stocking may not appropriately address a particular medical condition). They should conform to the legs and never be so loose in the feet that wrinkling or bunching would occur.
A stocking may be required on only one leg or both. There are generally four (some brands may offer five) different pressure groups, each with a suggested compression level for specific preventions and treatments.
Depending on what complication is being treated and the degree of necessary compression required, compression stockings can be purchased with or without a prescription.
If your doctor determines that you require a higher mmHg to effectively treat your particular need, then typically a pharmacy or medical supplies staff person will measure you for custom-made TED support hose.
Note that non-prescription mmHg ratio figures may vary depending on the manufacturer’s standard so check with your doctor to make sure you choose the correct size.
How much do graduated compression stockings cost?
The price of gradient compression stockings varies depending on the mmHg level and brand. For those that are custom-fitted (over-the counter non-prescriptive) compression stockings can range anywhere from $35-75. Custom-made (prescriptive) will cost considerably more ($300-350) as their mmHg level is beyond the range of those that are available over-the-counter in which case you would need to be measured by a physician or health care provider so that they will properly treat your specific disorder.
Are gradient compression stockings available for men and women?
Today women’s compression stockings can resemble an elegant pair of pantyhose. Both ultra sheer and opaque women’s compression stockings come in a wide variety of compression levels, colors, opacities, styles (open or closed-toe), and sizes to complement any occasion or to match your wardrobe preferences.
Gradient compression stockings for men are now more dressier. Compression stockings are also available for men and women in knee-high, thigh-high, and pantyhose and are available in black, beige, and white.
Maternity support hose styles are also available for during pregancy.
Depending on what specific condition they are treating, compression stockings are available in three different styles (foot to knee, foot to thigh, and foot to waist).
Normal compression lasts six months giving the user more time before having to replace them. Gradient compression stockings for women are available in a few different choices of color (Most support hose for women of color are not available in various skin tones.), patterns, and weaves.
How do you put on compression stockings?
When possible, it is recommended that compression stockings be put on first thing in the morning before getting out of bed.
Some practice is required to wear compression stockings. They should be strong but not unnecessarily tight. If you have weak hands or arthritis, getting these stockings on may be difficult.
There are devices to make putting them on (donning) easier. When donning, stockings can either be turned inside out or a very small amount of silicone lotion, baby power, or corn silk can be applied to assist in pulling them up.
A good deal of pulling is required to get the stockings past the ankle and for the elderly or immobile, assistance may be required.
For some, putting on a pair of compression stockings may be physically difficult as it requires bending and reaching. Also, if you are a diabetic with neuropathy in your feet or your legs are swollen and the skin is taunt and dry, you’ll need to be careful as you are more prone to scratches.
In either case, it is recommended that you have someone put them on for you.
Consider the following technique:
- If your compression stockings are new it might help to first hand wash them. This can make the stockings more flexible and easier to put on.
- If you have an open wound make sure you put a dressing on it before putting on the compression stockings.
- Sit in a chair with a back while you put on the stockings. This gives you something to lean against as you pull up the stockings.
- It is usually best to put on the stockings early in the morning when you have the least swelling in your legs. Put silicone lotion (such as ALPS) or talcum powder on your legs to help the stockings slide on.
- To ensure against snagging the material first remove any jewelry (rings) and do not forcefully pull on them. Using latex gloves may help grip the fabric. For a toeless stocking wear a silk “slip sock” to help the stocking slide over your foot more easily.
- Turn your stocking inside out and place your toe in as far as it will go. Readjust the stocking by folding it back onto itself at the ankle and grab both sides of the folded stocking. Pull toward your body as far as you can. Fold back the stocking again farther up on your leg and pull the stocking up to that point. Repeat folding back and pulling until the stocking is correctly placed. Pull the slip sock off through the open toe when you’re done.
If you’re still having difficulty with putting on compression stockings there are a plethora of brands Donning gloves and other Donning Aides on the market (e.g. Medi Butler Off (The doffer), a metal device that holds the stocking open while you step into it, the Arion Easy Slide Closed Toe Application Aid, Jobst Stocking Donner, Mediven Medi Extendable Handle Donner for large calves, and Juzo-Slippie Gator Set
There is also a popular device for taking them off called Sock-eez. It is a trouble-free device that is designed to enable those who have trouble removing normal hosiery, compression socks, and compression stockings (e.g. the elderly, the disabled, those with chronic back problems, and post-operative patients).
Every day, have your stockings at your bedside, ready to put them on before you get out of bed. Once you or someone else has mastered the technique, you’ll find this becomes a regular part of your daily routine.
If your stockings are properly fitted, they should feel comfortable when you have them on.
Why do compression hose slip down?
If your compression hose are non-prescriptive and they continue to slip down, it could be due to one or more of the following reasons:
- You aren’t wearing the correct size
- Your body shape (i.e. loss or gain of weight) has changed.
- Dirt or grime has permeated the silicone in the stocking(s) fiber that can cause loss in elasticity.
If the silicone is clean and you stockings are the correct fit, but they continue to slip down, you may want to try using a garter belt or switching to compression pantyhose.
Products such as It Stays also help to keep your stockings up and in place.
How much do compression stockings cost?
Non-prescriptive (over-the-counter custom-fitted) gradient compression stockings to include anti-embolism hose prices can range from $11-65 per pair depending on their compression; the higher the compression the more expensive (prescriptive custom-made TED hose can run as high as $375, particularly those made in countries like Germany or Switzerland, and generally they are not covered by medicare or other insurance companies.)
How do I wash compression stockings
- Hand-wash in warm water (never machine wash them) using a non-phosphate detergent such as Jolastic, Tide Free, or ERA to maintain their elasticity.
- DO NOT use hot water (more than 100 degrees) as it will damage the fibers. Rinse in cool or cold water.
- Never use a liquid soap that contains fabric softeners (softeners can breakdown the elasticity of the material), bleach or a soap with stain remover.
- After hand-washing, do not wring or twist compression stockings. Instead, lay them on a towel and pat dry to remove excess moisture.
- Air dry at room temperature (never dry in direct hot sun or near a source of excessive heat, such as radiator heat, as this can also damage its fibers) either by hanging or laid flat on a dry towel. My father-in-law air dries his compression stockings on a hanger using a bull dog clip attached to the toe-end.