FAQ about Compression Stockings
Posted on November 10, 2009
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WHAT ARE COMPRESSION STOCKINGS?
Compression stockings come in two different types: Gradient and anti-embolism.
Gradient compression stockings are specialized long thin hose that are made of strong elastic material that are worn from the foot to the knee or thigh. They provide a gradient of pressure (tighter in the foot and gradually decreasing to the top of the stockings). The pressure in the stockings is graded, which allows the stockings to constantly squeeze the leg muscles. This pressure helps to drive blood back to the heart, reduce swelling in the feet, and prevent blood clot formation.
Anti-embolism stockings are commonly referred to as TED (ThromboEmbolic Disease) hose. They are used to support the venous and lymphatic systems of the leg. Unlike gradient compression stockings, anti-embolism hose deliver an equally distributed amount of compression at the ankle and up the leg. This compression, when combined with the muscle pump effect of the calf, aids in circulating blood and lymph fluid through the legs in non-ambulatory patients (those who cannot get around or are post-surgical.
There was a time when some people thought of compression stockings as being uncomfortable and unstylish, but their negative fashion reputation is no longer an issue for most considering their benefits.
WHAT ARE SOME OF THE COMMONLY USED TERMS FOR COMPRESSION STOCKINGS?
Anti-embolism hose – TED hose, which are worn by those who are non-ambulatory (unable to get around) or post-surgery patients. This type of compression stocking helps to prevent pooling of blood in the legs that could lead to a venous thrombosis.
Custom-made stockings – This type of stocking is prescriptive and is uniquely made for a specific individual’s condition.
Circular knit stockings – This is a Seamless stockings that offers a more pleasing aesthetic appeal.
Flat knit stockings – Stockings that are generally often used in higher compression classes with a seam that can be constructed in virtually any shape or size.
Lymphedema hose – This type of compression stocking used to manage edema resulting from the onset of Lymphedema.
Support hose – Mild compression stockings that are sold over-the-counter and without a physician’s prescription
WHAT ARE COMPRESSION STOCKING USED TO TREAT?
Wearing the compressing stockings for conditions such as varicose veins is often the first approach to try before moving on to other treatments. Compression stockings steadily squeeze the legs, helping veins and leg muscles move blood more efficiently. The amount of compression varies by the type and the brand.
Compression stockings are a simple therapy method of treating disorders (, prevention of blood clots in the leg). There are a number of conditions that compression stockings can be useful in treating (e.g. varicose veins, chronic venous insufficiency, varicose veins, lymphedema, post phlebitic syndrome, management of large scars, venous skin ulcers, post-surgical recovery, venous disease, edema, and blood clotting). They do not eliminate varicose veins, but will help to reduce swelling along with the aching and heaviness that individuals feel with varicose veins.
Graduated compression therapy compresses the surface veins, keeping their diameter small, increasing blood flow, thus helping relieve the symptoms of venous insufficiency. For some, it may be necessary to wear compression stockings daily for years and in some cases for the rest of their lives. It should be noted that compression socks are not recommended for people who have peripheral neuropathy. Like compression socks, compression stockings can also be worn for long periods of inactivity such as long-haul plane trips (four hours or more) or long car trips as they help to decrease tired and aching muscles and any probability of blood clot formation in the legs.
Keep in mind that wearing compressions stockings, especially prescriptive ones, may involve hidden dangers if not used appropriately. Compression stockings should not only be measured for a perfect fit, but, for the appropriate medical condition as well. For example, in cases where a person is suffering from severe neuropathy, consultation with a neurologist or physician is highly recommended as opposed to relying on self application of compression stockings.
Compressions stockings are especially good for pregnant women, whose venous system is subject to twice the normal strain during pregnancy. The veins have to transport an increased volume of blood and the higher concentration of progesterone can have a negative effect on them.
HOW LONG SHOULD COMPRESSION STOCKINGS BE WORN?
Compression stockings should be worn during the day and removed at night as long while there there is an increased risk of forming blood clots in the leg. Whenever possible, wearers should keep their legs elevated at night when not wearing the stockings.
HOW ARE COMPRESSION STOCKINGS WORN?
When purchasing compression stockings, make sure that they fit properly. Using a tape measure, (you or your pharmacist) measure the legs to ensure you get the right size and fit according to the size chart found on the stocking package. Compression stockings should be strong but not necessarily tight. If you have weak hands or arthritis, getting these stockings on may be difficult. There are devices to make putting them on easier.
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. To put them on the stockings can either be turned inside out or a small amount of silicone lotion 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.
Compression stockings are available in various sizes, colors, and pressures and having the proper size is extremely important (they are made to fit your calf diameter, not foot size). They can be purchased without a prescription or an order from a doctor, although because not all pharmacies are equipped to properly measure a person’s legs the risk of the wearer not getting a proper fit especially for those who suffer from sever cases of varicose veins, it is recommended that the wearer’s doctor determine the correct compression level (mmHg). Compression stockings are more expensive than regular stockings. After determining the proper pressure (fit), they can often be found online at better prices than what can be expected to pay at pharmacies or medical supply stores.
A stocking may be required on only one leg or both. There are generally five different pressure groups, each with a suggested unit of measurement range (mmHg) 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.
WHAT IS THE DIFFERENCE BETWEEN COMPRESSION STOCKINGS, DIABETIC SOCKS, AND SUPPORT SOCKS?
Compression stockings are firm compression stockings whose compression level is 20mmHg and higher, while support stockings are generally light compression stockings whose compression level is below 20mmHg. Compression Stockings are generally for more serious venous diseases such as acute leg/ankle swelling, varicose veins, lymphedema, and chronic venous diseases. Diabetic socks provide enough compression to conform to the foot and to keep from falling down around your ankles, but not so much as to restrict circulation in the feet and legs. Support stockings provide relief of tired legs, mild swelling, spider veins, and as a prevention for patients at risk for developing varicose veins. Compression socks, like support stockings, also provide a light compression below 20mmHg, but, are somewhat thicker. And like support socks, they are typically worn to relieve tired legs, mild swelling, spider veins, and as a prevention for those at risk for developing varicose veins and a tendency toward blood clotting.
WHAT SHOULD I LOOK FOR WHEN PURCHASING GRADIENT COMPRESSION STOCKINGS ONLINE?
- Be sure and read all of the information provided by company.
- Look for customer reviews about the company’s products.
- Find out if the company is a member of the Better Business Bureau.
- Always call the BBB when you are unsure of a company.
- Find out if they have a Yahoo or Amazon shopping rating.
- Check to see if they offer different methods of payment , such as by credit card, or an order form where you can send a check or money order.
- Look for their telephone number so you can order by telephone.
- Check to see if their customer service representatives are certified by the manufacturers.
- And lastly, make sure they are an authorized dealer.
ARE GRADIENT COMPRESSION STOCKINGS AVAILABLE FOR MEN AND WOMEN?
Compression stockings, or support hose, are made for both men and women for casual and dress wear. For women, compression stockings do not have to look like the old medical compression stockings. Todays medical compression stockings 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. Compression stockings are available in knee-high, thigh-high, pantyhose, and maternity support hose styles
SHOULD A DIABETIC WEAR COMPRESSION STOCKINGS?
Diabetics who suffers from poor circulation can and should wear compression stockings to minimize further swelling and or blood clots. Depending on the complication, a diabetic can wear them while swelling in the legs and feet is present and will most likely need to wear loose-fitting socks over the compression stockings. Compression stockings are often referred to as diabetic stockings, however, it should be noted that while many diabetics do wear them, not all wearers are diabetics.
They are particularly effective for diabetics with venous insufficiency, a complication that results in the valves in your leg veins being damaged. Normally the movement of the muscles helps to keep the blood flowing, but with venous insufficiency, blood can still pool around the ankle, the legs swell, can become discolored, and in some cases open sores can develop.
WHAT KIND OF DETERGENT SHOULD BE USED TO WASH COMPRESSION STOCKINGS?
Here are recommendations from most compression stocking manufacturers:
- 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.
HOW DO YOU PUT ON COMPRESSION STOCKINGS?
For some, putting on a pair of compression stockings may be physically difficult as it require a modicum of 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 help 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 are recommended by most manufacturers.Wearing rubber gloves may help grip the fabric. For a toeless stocking, wear a silk “slip sock” (from your medical supplier) 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 several Donning Aides that are available such as the “Medi Butler Off (The doffer)“, shown to the left. It is a metal device that holds the stocking open while you step into it. Although this device is often recommended for people who have trouble grasping, leaning, or pulling, try one before deciding to buy one—some people find them difficult to use.
Another “Donning Aid device is the “Arion Easy Slide Closed Toe Application Aid”. This one, shown to the left is what my father-in-law has, although he has a nurse who actually uses it to put on his stockings. At present, it retails for around $33.
Practically every compression garment manufacturer makes Donning Aids for both open and closed toe compression stockings and TED hose. The better ones are made by Jobst (Stocking Donner 110913), Mediven (Medi Extendable Handle Donner for large calves), and Juzo (Slippie Gator Set).
Talk with your health professional or the certified fitter at your medical supply store about any difficulties you might have with your compression stockings. Call your doctor if your toes get numb or painful or turn dark while you are wearing compression stockings.
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 I KEEP COMPRESSION STOCKINGS FROM SLIPPING DOWN?
If your compression hose are non-prescriptive and they continue to slip down, it could be due to a few 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.
WILL THE MATERIAL OF COMPRESSION STOCKINGS CAUSE BLISTERS?
The short answer is yes, though this is not typical. If a lotion is used on the legs prior to putting on the hose, this can create a barrier between the stocking and the skin that will act as a lubricant. If the fit of the stockings are such that they allow for movement against the skin, no matter how miniscule, friction will occur, which, if prolonged, can create a blister.
WHERE CAN NON- PRESCRIPTIVE COMPRESSION STOCKINGS BE PURCHASED AND WHAT ARE THEIR COST?
Depending on the specified range of pressure your doctor recommends for legs and feet, non-prescription gradient hose can be purchased from a online retailers such as Amazon, distributors, or through your local pharmacy and medical supplies store.
Compression stockings can be purchased from a medical supply store with a doctor’s prescription and may cost between $60 and $100 a pair, with panty hose style running a bit more expensive. Typically they will need to be replaced after 4 to 6 months of regular use. Compression stockings are also available without a prescription, however they do not provide the higher level of compression needed to prevent venous skin ulcers.
Typically compression stockings are priced based on the compression or pressure range (mmHg), special features (i.e. open toe, open heel), and length (ie. knee-high, thigh-high, panty hose). For example 15 -20 mmHg is considered to be in the moderate price range, while the same style in a 40 and above mmHg range will cost nearly twice that amount. So, based on that, it is wise to shop around as prices will vary from retailer to retailer.
FURTHER INFORMATION REGARDING COMPRESSION STOCKINGS:
This following press release was submitted to American Journal of Nursing
A study published in the American Journal of Nursing (AJN) indicates that graduated compression stockings were used incorrectly in 29 percent of wearers and sized incorrectly in 26 percent of wearers.
“Problems with the use and sizing of graduated compression stockings are common throughout the US, and this study is one of the first to systematically analyze the problems and recommend ways to improve practice,” said Elizabeth H. Winslow, PhD, RN, FAAN, Research Consultant, Presbyterian Hospital of Dallas, Texas, and lead author of the study, in a press release. “Based on the study findings, we recommend that knee-length stockings be the standard length used and that the education of nurses and patients about the proper use of stockings be improved.”
This study and previous research has found that problems with use and size were more common with the thigh-length stockings and in overweight patients. More patients who had thigh-length stockings found them uncomfortable than did those who had knee-length stockings and 20 percent of patients did not understand the stockings’ purpose. This lack of understanding may play a role in patient’s failure to wear them correctly.
Graduated compression stockings increase blood flow velocity, reduce the risk of venous wall dilation and intimal tear, improve venous valve function, and possibly reduce coagulability, all of which reduces the risk of venous thrombosis (a blood clot that forms in a vein).
Many studies conducted over the past three decades have shown that graduated compression stockings, used alone or in combination with other external compression devices or medications, significantly reduce the rate of deep-vein thrombosis in post-surgical patients. Research conducted in the 1980s and 1990s suggested that thigh-and knee-length compression stockings are equally effective in reducing deep-vein thrombosis, but there are few recent studies.
“A lot can be done to optimize the benefits of graduated compression stockings and minimize adverse effects,” said Debra Brosz, MSN, RN, ONC, NEA-BC, a researcher at Presbyterian Hospital of Dallas and coauthor of the study. “Knee-length stockings have many practical advantages over thigh-length (TED Hose) in that they lower the risk of problems and healthcare costs. The improper use and sizing of these compression stockings and the deficiencies in patient education are important healthcare issues.”
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