Wednesday, September 17, 2008

Graduated Compression Stockings

It is well established that graduated compression stockings (photo credit) are useful in preventing deep venous thrombosis (DVT). Like many things, they only help if used and if used properly. A recent study showed that up to 26% of patients had the wrong size stockings. So in an attempt to help patients and professionals (nurses, physicians, etc), here is some information on choosing the correct size.
 

For the compression to graduate (20-30 mmHg at the ankle, 10-24 mm Hg at the upper calf, and 4-12 mmHg at the upper thigh), the fit is very important.

The sizes on most support stockings are determined using a few simple measurements, but these measurement are important in the proper fit. As the measurements are taken, they should be recorded and then compared to the sizing chart of the manufacturer (ie Jobst, Sigvaris, etc). This video shows how to take the measurements.

The following instructions and photos are from from the ForYourLegs website and are more complete.

STEP 1: Measure the circumference of your ankle. Measure around the narrowest part of your ankle above the ankle bone. Record this measurement...


STEP 2: Measure the circumference of your calf. Measure around your calf at it's widest part. Record this measurement...



STEP 3: Measure the length of your calf. Measure from the floor to the bend in your knee. Record this measurement...



STEP 4: Measure the circumference of your thigh. Measure around the widest part of your thigh just below your gluteal fold. Record this measurement...



STEP 5: Measure the length of your thigh. Measure from the gluteal fold to the floor. Record this measurement...



STEP 6: Measure around your hips. Locate the widest part of your hips or waist and measure all the way around. Record this measurement

If the patients thighs measure more than 25 inches, then knee high rather than thigh high stockings should be used. Off-the-shelf stockings can not maintain the correct graduated pressure when the patient's thighs are larger than 25 inches.

Now that the correct size has been chosen, how do you put them on? The following information is from the second reference below, ClotCare Online Resource.

Applying graduated compression stockings may be difficult if your leg is significantly swollen and/or the pain is severe. To make it easier to put the graduated compression stockings on, first lie down and elevate your feet above the level of your heart for several minutes to reduce the swelling in your legs and ankles as much as possible. Then put on the stockings as you would any pair of socks or pantyhose.

Here are some tips for best results when using graduated compression stockings:

  • Wear gradient compression socks or stockings everyday.
  • Use rubber gloves to get a better grip on the fabric.
  • If you cannot tolerate wearing the stockings all day, wear them for a few hours at a time and increase the amount of time daily.
  • Put compression stockings on first thing in the morning.
  • If your skin is moist apply cornstarch or grease-free talcum.
  • Keep legs and feet warm to promote good circulation.
  • Stockings will typically last 3-6 months.
  • Proper fit is essential for effectiveness.
  • Take notice of weight loss or gain as this may affect the fit.
  • Pay special attention to washing instructions.
  • Do not allow wrinkles in the stockings.
  • Do not cut or alter stockings.
  • Never fold or roll them down.
  • Remove stockings if prolonged numbness or tingling occur or if you note bluish discoloration.

There is a very nice video on Dr Joseph Caprini's website discussing the use of and application of compressions stockings. Go to his site and then click on the "Rational and Use of Compression Stocking" button, choosing broadband or dial up. Really worth watching.

 

Here are several manufacturers who make compression stockings.

Jobst -- includes instructions on donning and care.

  • Jobst Anti-Em/GP stockings are latex free
  • Three styles are available: Knee-Hi, Thigh-Hi and Waist-Hi

Medi

Sigvaris

Juzo -- included instruction on donning and care.

 

REFERENCES

Graduated Compression Stockings Should Be Properly Sized and Used; Medscape Article, Sept 9, 2008; Laurie Barclay MD and Desiree Lie MD

What are graduated compression stockings, where do I get them, and how do I put them on?; ClotCare Online Resource, updated June 2007; Ruth Morrison, R.N., B.S.N., C.V.N., Henry I. Bussey, Pharm.D., FCCP, FAHA, and Marie B. Walker

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3 comments:

enrico said...

What an incredibly lucid and informative treatment on this deceptively simple topic. Proper fit can mean the difference between wasted money/effort and worsening the problem, even tissue damage. My cankles and I (I can't believe I shared that) have had to deal with these beasties for post-operative edema on a couple of occasions, and they're no picnic; I can't imagine having to use them ALL the time, but the consequences of not taking care of PVD or what have you is far worse.

Complicating the initial therapy is that proper fit and usage will seem uncomfortable--anything less means you probably aren't getting the proper support/pressure--but it shouldn't outright hurt. For different people's pain perception, that can be tricky. Thankfully it doesn't apply to me, but I've seen patients with underlying neuropathy that clouded this distinction as well.

Anyway, just wanted to say that once again you do the medical blogosphere a great service elevating a seemingly mundane topic to truly informative. Cheers! :)

SeaSpray said...

Wow...great post! Most informative. I like the lie on bed/elevate legs idea prior to putting them on.

I am supposed to wear them and got my 1st pair in the spring. Very tight and I loved how they felt on my legs...but... they cut so badly into my ankle/front foot area that I could not keep them on because I was having pain in foot and above ankle that I never had before. There was a huge indent after I removed them. I tried one more time and couldn't do it and was disappointed because as I said..my legs felt good.

I have yet to tell the vascular doc.

Then the OR has a policy now where you have to wear those white stockings prior to going in but they weren't as tight and so I wore them.. back in June. Then in August I couldn't because I was more swollen and they were cutting into my ankles and the SDS nurse thought that would be counterproductive to their purpose.

I appreciate Enrico's comment about hurting and tissue damage and wondered if I was hurting myself by leaving them on when home. When the foot and above ankle were hurting so much... I knew they had to come off. My legs/ankles swell but they do not hurt.

I hope you don't mind but I am copying your post for future reference and thank you for posting it. :)

barbara said...

Imagine my surprise to find your website while searching for a good price on support stockings! I own and operate the QuiltSoup pattern company and see that you like applique as well. You might want to take a look at what we do. And thanks for the info on the socks!