Pharmacy student and part-time staff member, Lauren, has come to pharmacist Parveen with a question about her coursework...
“We had a whole afternoon this week about compression hosiery,” Lauren tells Parveen, “but it was all about measuring and fitting, and what to look for on prescriptions. There wasn’t any explanation as to when to use what. When do you use class 1 instead of 2 or 3, for example, and who needs an open-toe and who needs a closed-toe stocking?”
Compression hosiery can appear bewildering, but as a general rule:
- Class 1 stockings are used for varicose veins; class 2 for more severe varicose veins, venous eczema, healed venous leg ulcers, superficial thrombophlebitis and lipodermatosclerosis; and class 3 for the prevention of postthrombotic syndrome after a DVT. There is some flexibility within this and the patient’s tolerance level should be taken into consideration. For example, if someone with venous eczema finds class 2 stockings too painful, class 1 should be used rather than stopping the treatment altogether
- Thigh-length hosiery is recommended for those with severe varicose veins above the knee or swelling that extends to this level. Below knee stockings are recommended for the prevention of recurrence of venous leg ulcers, or if thigh-length cannot be used or is not tolerated
- Open-toe versus closed-toe is a personal preference. The advantages of open-toe is that some find them easier to put on and less hot to wear – so it is possible to wear socks over the top – but they can ride up, cause the toes to swell and exacerbate painful foot joints
- Removal of stockings should be done at bedtime – with emollient applied to reduce skin dryness and irritation – and then put back on first thing in the morning before any swelling has developed or worsened, using an application aid if necessary. If this isn’t possible, they should not be worn for more than seven days continuously
- Replacement is necessary every three to six months, or earlier if they become damaged or stretched. Ideally a second (item or pair) should be provided to allow time for laundering; handwashing at around 400C and drying away from direct heat is recommended
- Review patients every three to six months to reassess the condition the hosiery is being used for, and check adherence and measurements.
The bigger picture
Compression hosiery is used in the management of conditions associated with chronic venous insufficiency. They increase venous blood flow by improving the action of the calf muscle pump through the exertion of graduated pressure.
Extend your learning
Talk to a couple of patients to whom you dispense compression hosiery – what matters to them? By understanding this, you will gain some insight into what affects their adherence.