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Compression stockings

Your doctor may ask you to wear compression stockings before surgery and to continue wearing them during your hospital stay. This factsheet provides some information and advice about why it's important to wear compression stockings and how to take care of them.

There are different types of compression stockings available, so it's important to follow your doctor's advice and read the manufacture's guidelines.

What are compression stockings?

Compression stockings (also called TED or thrombo-embolic deterrent stockings) are usually worn to help maintain circulation and reduce the risk of blood clots forming in the veins of your legs (deep vein thrombosis, DVT). For more information, please see the separate BUPA health factsheet, Deep vein thrombosis.

Certain risk factors make DVT more likely to occur, such as being over 40, overweight or if you have a family or personal history of DVT. Other factors that increase the risk of DVT are listed here.

• Prolonged bed rest (reduced mobility).
• Surgery - especially if it lasts more than 30 minutes, or involves the leg joints or pelvis.
• Certain medicines - such as the contraceptive pill or HRT, can cause the blood to clot more easily.
• Pregnancy and childbirth - hormonal changes during pregnancy make the blood clot more easily and also the added pressure on the veins of the pelvis can increase the risk of DVT. There is also risk of injury to veins during delivery or a caesarean. The risk is high just after childbirth.

Preventing a DVT during your hospital stay

Hospitals often do a pre-operative risk assessment for DVT, which takes into account your personal risk factors and the type of treatment or surgery you are having.

Various measures can then be used to keep the risk as low as possible. These include anticoagulant (blood-thinning) medicines, compression stockings and an intermittent compression pump.

The intermittent compression pump is a mechanical device that automatically squeezes the feet and lower legs. This helps maintain circulation in the legs in the first few days after surgery.

Your doctor will recommend appropriate preventive measures for you. In most cases, patients are asked to wear compression stockings before surgery and to continue wearing them during their hospital stay.

Patients having quick and simple procedures under a local or general anaesthetic may not need to wear compression stockings.

Research has also shown that some patients can still be at risk of DVT after going home from hospital. Depending on your personal risk factors and the type of treatment or surgery you are having, your doctor may ask you to continue wearing your stockings at home for a few weeks.

On admission

When you arrive at the hospital, your nurse will explain how you will be cared for during your stay and assess your risk for DVT.

Compression stockings are available in several sizes and lengths. Your nurse will measure your legs and recommend the correct compression stockings for you.

Stocking size and length will be written in your records but it may be necessary to re-measure your legs if they are swollen after surgery.

Your nurse will show you how to put the stockings on and may also give you advice about washing and taking care of your stockings once you are at home.

Your nurse will also teach you foot and ankle exercises that will help encourage blood flow through your legs.

How to put on compression stockings

Graduated compression stockings are tighter at the foot than higher up the leg. They are difficult to put on and take off, and you may need someone to help you with this.

• Knee-high stockings should sit below your knee.
• The stocking border of thigh-high stockings should rest below your buttocks.
• The body part of your waist-high stockings should rest around your waist with the seams running vertically up the front of the garment.

1. Insert your hand into the stocking as far as the heel pocket.

2. Turn the stocking inside out.

3. Carefully slip your foot into the sock and ease the stocking over your heel. Please check your heel fits into the heel pocket.

4. Bring the rest of the stocking over the heel up around your ankle and calf - don't pull the stocking - gently massage the stocking upwards using the palms of your hands.

Caring for your stockings

You may need to wear your stockings for several weeks after you go home from hospital. It is important that you take care of your stockings and wash them regularly. You may be given a spare set to wear while washing the first set.

Washing instructions

• Machine or hand-wash using warm water, max 40°C, every 2 to 3 days.
• Don't wring the stockings as this action can damage their effectiveness.
• Don't tumble-dry the stockings as the heat may damage the elastic.

Wear and care

To be effective, stockings need to be worn constantly during the day and at night. However, you should take them off for at least half an hour every day to wash your legs and check the condition of your skin. When checking your skin you need to look out for:

• any changes in skin colour on your legs or feet
• any sore marks at the top of your legs
• any sores on your toes or feet

Don't put your stocking back on if you spot any of these signs or if you are worried. Please contact your district nurse or doctor for advice.

Points to remember

• Smooth out any creases and never roll down your stockings whilst wearing them. This can affect their performance and may restrict blood flow through your legs.
• Keep ointments, oils, lanolin and similar substances away from your stockings as they can cause the elastic to deteriorate.
• Don't sit still or lie in bed for long periods. Try to take regular walks around your home and do gentle foot and ankle exercises when sitting down. This will help blood flow through your legs.
• When you are sitting or lying down keep your legs uncrossed.

Further information

• The Thrombosis Charity
  01406 381017
  www.thrombosis-charity.org.uk

Sources

• Scurr JH, Coleridge-Smith PD, Hasty JH. Deep venous thrombosis: a continuing problem. BMJ 1988; 297:28
• Jeffery PC, Nicolaides AN. Graduated compression stockings in the prevention of postoperative deep vein thrombosis. Br J Surg 1990; 77:380-383
• Amaragiri SV, Lees TA. Elastic compression stockings for prevention of deep vein thrombosis. The Cochrane Library.
  www.cochrane.org
  accessed 7 November 2005
• Thrombosis and pregnancy. The Thrombosis Charity.
  www.thrombosis-charity.org.uk
  accessed 7 November 2005

Published by BUPA's health information team, healthinfo@bupa.com, December 2006.

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