Compression hosiery is the main stay of treatment in chronic oedema. Without the application of hosiery, any reduction from compression bandaging will be short-lived and the oedema will rebound. Before applying compression stockings, assessment of the arterial circulation is necessary to ensure compression can be safely applied. Other contraindications to the application of compression include:
- Advanced peripheral arterial occlusion
- decompensated cardiac insufficiency
- septic phlebitis
- acute cellulitis
- acute DVT
Application of compression requires a significant degree of skill and knowledge. It is your responsibilty to identify any education needs regarding this and subsequently sourcing appropriate training. Many of the hosiery companies can provide training.
There is a wide range of garments available on prescription giving a choice of flat knit or circular knit garments.
Flat knit hosiery is preferred if the legs are fatty and if there are pronounced skin folds especially the ankle. Flat-knit stockings are knitted stitch by stitch to precisely follow the contours of the body. The fabric is joined with a flat, elastic linking seam. The thicker fabric offers a lymph draining effect when treating lymphedema or lipoedema. The flat knit stocking won’t yield to oedema. In conjunction with movement, it produces a high theraputic pressure providing optimum compression of the tissue. The majority of flat knit garments require to be custom made
Circular knit garments can be used for mild swelling especially in venous disease, where there is a normal shape and intact skin. The majority of circular knit garments are off the shelf although if required can be custom made. Circular knit garments are often finer and more cosmetically pleasing.
General principles of wearing compression garments:
- Garments should be well fitting and comfortable.
- Garments should be applied in the morning and removed overnight (unless instructed to wear overnight by experienced prescriber e.g uncontrolled oedema that requires 24 hour compression or patients who don’t go to bed. A trial period is strongly advised to ensure this is both comfortable and safe. Factors to consider before advising 24 hour compression hosiery – stocking wont roll down in bed, patient has means to remove stocking if it is uncomfortable, skin is able to tolerate 24 hour compression without irritation or tenderness).
- Garments should be replaced every 6-9 months
- Garments should not be worn if the skin is ulcerated or leaking (unless very mild and wound care products can be applied under the stocking. If there is no improvement bandaging should be considered).
- Garments should not be worn if there is an acute cellulitis present
- Wearing a pair of household rubber gloves will make applying the stockings much easier
When choosing the compression of a garment it is often better to start with a class 1 compression garment and if well tolerated can be increased to class 2 if required. A little compression is better than none.
Click here for information on prescribing and measuring for “off the shelf” (ready made) garments but for further information on the role of hosiery in the management of lower limb oedema and guidelines on measuring for custom made garments, please click on below link:
International consensus document on Compression Hosiery
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