Compression treatment for venous problems

Compression stockings and bandages are a proven method to help manage venous disease by supporting the veins and preventing excess fluid build up.

Why use compression as a treatment?

There are 4 reasons for using lower limb compression:
  1. Relief of symptoms such as aching
  2. Prevention of  venous thrombosis (DVT and SVT)
  3. Management of complications of venous disease (chronic venous insufficiency)
  4. Acute thrombosis either deep or superficial
The types of compression are:

Bandages: usually multilayered (2-4 layers) and are a combination of lowstretch and highstretch bandage with a layer of soft wool to absorb pressure points. They often stay on for up to a week and need to be applied by a specially trained nurse.

Stockings: can be below knee, thigh high or pantyhose.

Grades of Compression

There is no single standard.  The higher compression at the ankle and the lower one is at the top of the stocking.

Class I – low compression (<20mmHg).  An example is the TED stocking used after surgery.

Class II – medium compression (20-35mmHg).  Used for venous disease or lower leg swelling.

Class III – high compression (>35mmHg).  Used for lymphoedema.

There are higher grade stockings used for burns patients.

The higher the compression the lower the willingness of patients to use them.

How do they work?

The aim of the compression is to squeeze the fluid from the lower part of the leg.  The stockings are graduated, meaning they are tighter at the ankle and not as tight at the top of the stocking so that the compression is similar to squeezing a tube of toothpaste.  The compression helps support the veins to make them narrower.  There is less stretching of the wall of the vein so the valves work more efficiently.  Compression should help reduce aching and improve venous return to the heart.

 

Precautions: One has to be careful in patients who have poor blood supply to the foot.  If there is doubt, it is wise to measure the arterial pressures at the ankle (ankle to brachial index).  This can be arranged through your local doctor.

Ways to make stockings easier to use?

  • Consider using a device such as the EzyAs
  • Wear washing-up gloves (better grip and less likely to catch nails and tear them)
  • Make sure the leg is dry.  Use talcum powder
  • Use the silk insert if one came with the stocking

IF YOU ARE USING STOCKINGS FOR CONTROL OF SWELLING:

  • Put them on before you get out of bed in the morning (have a fresh pair next to your bed)
  • Have your bath/shower last thing at night

SHOWERING – HERE ARE SOME OPTIONS:

  • You can buy special plastic covers
  • Shower with the stocking on and use a hairdryer to dry the stocking afterwards
  • Have 2 pairs.  Shower with the stockings on then lie on a bed.  Remove the wet stocking, dry the leg, then put the dry stocking on.

IF YOU ARE HAVING A LOT OF TROUBLE:

Use two Class 1 stockings (such as TEDs) on each leg.  Combined, they have the same compression as one Class 2 stocking.

 

Download an information sheet here