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Compression stockings

Discussion in 'General Issues and Discussion Forum' started by gush_horn, May 12, 2009.

  1. gush_horn

    gush_horn Member

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    Hi everyone,

    Been interested in finding out more about this topic, as I have limited knowledge. In the past i have simply been referring patients that I feel could benefit from compression to their GP. However, I have been feeling more and more recently that this is a little counter productive, as lower extremity health is part of my job description.
    So.. I was wondering if anyone had some good background on the prescription of stockings? Are there specific tests that might contraindicate compression (i.e. low toe pressures?)? rules for follow-up?
    I have been looking at the Jobst stockings and they seem to come in 3 main sizes:
    15-20 (medical prescription not required)

    Thanks for any help,
  2. pgcarter

    pgcarter Well-Known Member

    Hi Ben,
    If you want to get into this the best way may be to ring the suppliers of product, they will send a rep out to teach you all their recommended processes. I have had a session with a few of them in the past and have kept some Venosan product of the grade one 18-21mm compression, particularly the newer cotton based options which are much more comfortable to wear in warmer weather. There is also a nifty gadget for measuring the actual internal amount of compression insitu on a leg, which I had a look at a few years ago, it was about $750 and allowed you to physically check the amount of compression, which for grade 2 and 3 is probably a good idea.
    regards Phill Carter
  3. Johnpod

    Johnpod Active Member

    Hi Ben,

    In GB prescription is made on measurement of the leg at three points so all you need is a tape measure.

    Best to prescribe toe-less design, particularly with the higher compression models, as they can be fitted using a 'slipper' (or the corner cut from a plastic carrier-bag). Toed design serves no purpose whatever and precludes use of this method - broken finger-nails and much grunting!!!!

    Those with toe in also cause lateral compression of toes, H molle, damage from adjacent nails, etc.

    Biggest problem? They are so difficult to fit/remove that care staff often duck the job and the patient might have to wear them for several days without respite.
  4. pgcarter

    pgcarter Well-Known Member

    Funny thing that, when we ran an audit of compression stockings in the hospital where I used to work we had three times as many reported problem with the ones without toes because people would always have trouble knowing how far to pull them on and the end would always cause a bit of a compression ring around the foot, more trouble than I've ever seen with ones with toes in them.
    regards Phill
  5. gush_horn

    gush_horn Member

    thanks for the replies!
    will definitely get give a few reps a call.
    Really do think this is area that Pods could really utalise with patients that are at risk of breaking out with a VSU (Venous stasis ulcer).
    Will post what i conclude from talking to the reps.
  6. Elizabeth

    Elizabeth Member

    Before issuing compression stockings it is important to do an assessment, including doppler assessment to establish whether there is any PAD.

    There are now some very good aids to applying compression stockings which are available on prescription. Sockaid (which is very easy for those with weak hands) and actiglide.
  7. NewsBot

    NewsBot The Admin that posts the news.


    Compression stockings

    Compression stockings
    Compression stockings

    Compression stockings are a specialized hosiery designed to help prevent the occurrence of, and guard against further progression of, venous disorders[1] such as edema, phlebitis and thrombosis. Compression stockings are elastic garments worn around the leg, compressing the limb. This reduces the diameter of distended veins and increases venous blood flow velocity and valve effectiveness. Compression therapy helps decrease venous pressure, prevents venous stasis and impairments of venous walls, and relieves heavy and aching legs.

    Knee-high compression stockings are used not only to help increase circulation, but also to help prevent the formation of blood clots in the lower legs. They also aid in the treatment of ulcers of the lower legs.

    Unlike traditional dress or athletic stockings and socks, compression stockings use stronger elastics to create significant pressure on the legs, ankles and feet. Compression stockings are tightest at the ankles and gradually become less constrictive toward the knees and thighs. By compressing the surface veins, arteries and muscles, they force circulating blood through narrower channels. As a result, the arterial pressure is increased, which causes more blood to return to the heart and less blood to pool in the feet.

    There are two types of compression stockings, gradient and anti-embolism.[2]

    1. ^ FLA Orthopedics (2004). Graduated Compression Hosiery and Socks. Miramar, FL. pp. 19–20. 
    2. ^ DoctorQA. "Compression Socks". Retrieved 23 March 2012. 
  8. dgroberts

    dgroberts Active Member

    But.....and this is just thinking out loud.......in the UK you would have to refer back to the GP anyway for the prescription to be issued, otherwise where is the money coming from to pay for them?

    There may also be an issue with causing the GP to lose out on QOF points, and therefore money, not 100% sure though.
  9. Elizabeth

    Elizabeth Member

    well quite, so it would be better to leave it up to the GP (or rather, the practice nurse).
  10. carolh

    carolh Member

    Hi, I would be very wary of 'prescibing' compression hoisery, it is usually prescribed by practice nurses and district nurses after full assessment to rule out arterial incompetancy. PCT's usually have formulary rules as to which can be prescribed so it is not good to suggest a specifc type to the client. I would also caution the use of open toe stockings as I have experianced a patient who pulled hers back and caused a tourniquet effect with fairly dire consequences which took months and months to heal.

    A referral/recomendation to visit a suitably qualfied nurse would be a safer course of action.

    My background is as a qualfied district nurse and nurse prescriber, with a lower leg management qualification at level 3 and had daily experiance of such things, I am now retired and wouldn't touch compression hoisery with a barge pole!

  11. cornmerchant

    cornmerchant Well-Known Member

    I would agree with Carol.

    Provision of compression stockings is not within the remit of the podiatrist in the UK.

  12. cwiebelt

    cwiebelt Active Member

    I also agree with Carol and others
    The provision of compressive stocking seems so simple but there is more to it than one thinks.
    Check for PAD and any contraindications.
    also the correct selection of compression to be used is important.
    also is the client able put on the compressive stockings or will they need assistance?
  13. ELM

    ELM Member

    Sorry to add to this tread when it has been dormant for a while, but found it interesting that the only argument against toeless compression stockings to be incorrect application - I was accosted by a district nurse in the corridor of our hospital a couple of days ago, and got a proper telling off for telling one of our patients about toeless stockings, instead of the full ones she had which caused her pain. According to the district nurse, these dont exist. I have since found plenty of toeless options, and will present her with the evidence soon.

    The district nurse is trying to heal a leg ulcer, I am trying to keep pressure off a lateral 5th IPJ ulcer - toe ulcer was present at the time the nurse reccomended and dispensed full compression stocking. :bang:

    Does anyone have a particular brand they prefer? I will be contacting company reps to get a demonstration also...
  14. Tuckersm

    Tuckersm Well-Known Member

    Try MediGroup

    They have a 2 layer bandage system which makes the application and weight of the stockings much lighter than many others, with multiple sizes available (see their fitting chart)

    Medigroup also sell the Kikuhime Sub Bandage Pressure sensor and we purchased it for around $500 last year
  15. l.heys

    l.heys Member

    Supply of compression stockings should be left to the nursing team (my pennies worth).

  16. Tuckersm

    Tuckersm Well-Known Member

    I find that very interesting, when a whole range of compresion stockings are available from some pharmacies and medical supply stores (at least here in Australia) for a person to walk in off the street and purchase from a shop assistant.

    Yes compression therapy can be a complex issue, and as such oedema will often go unmanaged (as that can be the easier option for the clinician), which in some cases will progress to lymphoedema.

    When instigating any therapy it is a matter of competance, so the selection and application of compresion therapy should be undertaken by those who are competant, which can include podiatrists (as well as Physios, OTs, nurses etc.)

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