Important Advice for Those Who Wear Graduated Compression Stockings to Prevent DVT

Graduated compression stockings… no one would wear these because they feel good or look great. But, they are a medical necessity, to be prescribed by a doctor or nurse practitioner. This makes it a real problem since a recent study found that over a quarter of hospitalized patients wearing compression stockings were wearing the wrong size and/or using them incorrectly, rendering them useless.

Though they can feel tight, hot and itchy, compression stockings can actually save lives by reducing the risk of developing a deep venous thrombosis (DVT) or deep vein clot by 50%. These stockings are designed to promote blood flow by providing graduated compression — with the greatest compression at the ankle, and gradually diminishing pressure up the calf. The stockings work by squeezing your leg veins, keeping blood from pooling and helping it circulate back up to your heart. No surprise, they are now standard issue after many types of surgery. But, to be effective they need to be correctly sized and fitted.

SIZE MATTERS FOR COMPRESSION STOCKINGS

In a study of 142 hospitalized patients, led by Elizabeth Winslow, PhD, RN, nurse-researcher, and Debra Brosz, MSN, RN, orthopedic unit nurse manager, at Presbyterian Hospital of Dallas, the stockings were the wrong size 26% of the time and used incorrectly in 29% of the patients. These stockings can also cause serious skin problems when not correctly sized or used.

Busy health care professionals sometimes end up guessing what size a patient should wear, since measuring tapes and sizing charts are not always readily available, explained Dr. Winslow. She hopes one outcome of the study is that manufacturers will place a paper measuring tape and sizing chart on the outside of each package of stockings.

GUIDELINES FOR CORRECT USE

What can you do if you find yourself having to wear compression stockings? Here are the guidelines — check to make sure they’ve been followed by your health care provider.

  • Use knee highs. These are just as effective as thigh-highs, but easier to put on and more comfortable.
  • The appropriate way to measure for the knee-high stockings is to use the length of your leg from the back of your knee to the bottom of your heel and the width of the fattest part of your calf.
  • Make sure you are measured carefully (using the manufacturer sizing chart) by a health care professional or someone who has been trained to do this.
  • Look for wrinkles and see if the stockings roll down easily or if they leave red indentations in the skin from being too tight. These are signs of incorrect fit.
  • Have yourself refitted if anything changes — i.e., you gain or lose a substantial amount of weight or there is an increase in swelling.
  • Do not cut or alter the stockings in any way since this will make them less effective. They should not be folded or rolled down, since this could cause a tourniquet effect and block blood flow.
  • Take the stockings off for about 30 to 60 minutes every 12 hours. Check for skin irritation or redness.
  • Before putting stockings on, make sure your skin is completely dry — wait several minutes after bathing or it may be difficult to slide them up your leg.
  • It’s best to have two pairs of stockings — one to wash and one to wear each day. Stockings should be hand-washed with a mild soap or in the washing machine with warm or cold water. Hang them to dry or lay flat on a towel. They dry quickly.

Dr. Winslow says these stockings are not supposed to hurt or cause numbness. She urges patients who’ve been told to wear them to report such symptoms if they occur, and to be sure to comply with instructions on wearing them. (For more suggestions, see clotcare.com.) She also suggests keeping them, even after the doctor says you can stop wearing them — she says it is a good idea to wear them during long plane trips.

Graduated compression stockings look basic, but they’re actually manufactured to sophisticated research standards to deliver the correct amount of compression on the leg to enhance blood flow. The stockings only help if they’re used and sized properly. If you need compression stockings, insist on careful measurement of your legs and promptly report any problems with the stockings.