Compression Hosiery

1. Compression Hosiery Fiona Duncan Lymphoedema Clinical Nurse Specialist

2. Learning Outcomes • Why oedema occurs • The role of compression garments on the limb • To know where lymphoedema can occur • What information is needed when assessing patient • Different type of compression available • To identify indications for the use of compression garments • To know the different type of stockings that are available • To recognize the appropriate use of different styles of compression garments • To know considerations that have to be taken into account when considering hosiery • To understand the differences between compression garments • To know what aids are available to help patients apply compression hosiery • To be able to advise patients on how to correctly apply compression garments and how to take care of them

3. Why Lymphoedema/Chronic Oedema Occurs • Lymphoedemaoccurs due to an increase in the interstitial fluid volume • The role of the lymphatic system is to drain interstitial fluid • Lymphoedema occurs when there is a physical damage or an abnormality to the lymphatic system (such as lymph nodes being removed or being born without lymph nodes) • Tumours can block lymph nodes causing lymphoedema

4. Role of Compression Garments • Help to reduce mild, uncomplicated swelling • Contains and maintains a reduced limb size • Reduces the formation of excess interstitial fluid • Also reduces venous reflux and improves venous return • Limits the formation of lymph fluid in the tissues • Provides support for inelastic tissues • Maximises the effect of the muscle pump

5. Assessment Information • Extent of swelling • Skin condition • Limb shape • Below knee • Thigh length • Genital swelling • Arm swelling • Breast oedema • Any Shape distortion • Patients ability to apply and remove garments • Patients general health • Medical History • Do they already have vascular or arterial problems • Does the patient have heart failure • Look at toes do they have misshapen toes

6. Extent of Swelling • What part of the limb is swollen • Abdominal swelling • Genital swelling • Whole leg • Below knee • Foot only • Toes

7. Skin Condition • Do they have fragile skin which can break easily (this may be caused due to being on long term steroids) • Any varicose eczema • Any breaks to the skin • Any lymphorrhoea • Any allergy to latex • Are Fungal infection present

8. Dexterity • Does the patient have any arthritis in the hands (patients with this find it difficult to apply and remove stockings) • Are they obese (obese patients find it difficult to reach over there bellies to apply hosiery)

9. Types of Compression Garments Flat Knit Circular Knit • These are custom made garments • Expensive • Accurate measurements needed • “off the shelf garments” • Cheaper • Easily accessible • Some stockings come in different lengths (such as short, regular or long • Some stockings come in extra wide

10. Indications for the use of compression garments • Is the patient willing to wear hosiery • If the limb shape is regular may have to consider made to measure hosiery • Is the skin intact • Is the limb size suitable for a garment (most companies have a 7 or 8 size range) • Is the limb a regular shape

11. Types of Stocking Flat Knit Circular Knit • Flat knit garments can accommodate shape distortion • Number of needles used can be increased or decreased to produce variations in width and shape of garment • Does not twist, curl or tourniquet • Much thicker • Number of needle used is fixed • More cosmetically acceptable • Much thinner

12. Considerations When Choosing a Compression Garment • Compression class required • Colour (main colours are black and beige) • Material • Style (open or closed toe) • Possible allergies • Patients ability to apply and removed stockings • Will they need carers or family members to help them • May need layers of garments rather than a higher class of stocking

13. What to Consider When Choosing Stockings • Style – All swollen part should be included • Compression Class – a pressure gradient is required with the pressure being greatest at the wrist or ankle • Class 1 Mild compression • Class 2 Moderate compression • Class 3 Strong compression

14. Comparison of Hosiery Classification

15. Flat Knit Stockings - has seam up the back of the leg JobstElvarex JobstElvarex Soft

16. Circular Knit Hosiery - no seam

17. Altipress stocking liners 10 mm hg of pressure 3 in a pack. Easy to apply and patients can apply layers (only come in closed toe)

18. Activa Stocking Liners – 10 mm hg of pressure 3 in a pack and patients can apply layers (these come in open and closed toe)

19. Stocking Applicators Mediven 2 in 1 on prescription pip code 329-8932 code is DT904 Juzo Easy Fit on prescription pip code for large 393 9006 x large 393 8990

20. Stocking Applicators Actiglide can be used for stockings and arms sleeves on prescription pip code is Actiglide can be used for stockings and armsleeves pip code is 284-5196

21. Application Technique • Avoid using creams and oils on the skin (advise patients to wash and cream there legs at night) • Rubber gloves can be useful • Turn the garment back on itself at the wrist or heel • Ease the garment along the length of the limb in segments until in position • Use a aid if necessary

22. Advice for Patients Wearing Compression Hosiery • Show them how to apply and remove the hosiery • Inform them how to wash the hosiery (no tumble drying or putting over radiators as this shrinks the hosiery) • May need to show carers how to apply the hosiery • Comfort is a priority (if the patient finds the hosiery comfortable they are more likely to wear it) • Hosiery should fit snugly with no loose pockets where fluid can accumulate • Don’t leave patients with hosiery if they are unable to apply it or remove it or if they don’t have someone to help them