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Compression garments, hosiery or wraps, are used in the long term management of chronic oedema (usually following compression bandaging), prophylaxis and treatment of venous leg ulceration, and post DVT to prevent post thrombotic syndrome. They may be used with caution for diabetic foot ulceration with oedema, or cardiac oedema, under the direction of a competent practitioner. Please see for additional guidance: NICE CKS Venous Leg Ulcer (February 2016).
Damage to the limb can occur if bandages are applied inappropriately and have led to major amputation. They should not be used for a patient that is in the acute phase following a stroke.
The use of graduated compression bandaging, hosiery or wraps, correctly applied, and combined with exercise, is the treatment of choice in venous ulceration. Compression bandaging, hosiery or wraps, may be used in the treatment of mixed aetiology ulcers or where there is suspected arterial incompetency.
If an Ankle Brachial Pressure Index (ABPI) is between 0.5 and 0.8, or above 1.4, consult a vascular surgeon, tissue viability nurse, or lymphoedema specialist before considering compression treatment.
Leg ulcers should be reviewed and reassessed at least every four weeks, the patient should be monitored at each dressing change and the treatment, including any compression therapy reviewed.
Chronic oedema is a term used for all forms of oedema that persist for 3 months, irrespective of aetiology. It can be mild to severe; simple or complicated; and with or without wounds.
Investigations should be done to determine the cause and treatment instigated for acute oedema, to reduce and stabilise before addressing and implementing compression therapy. Additional advice is available from the the specialist teams listed below.
Compression measuring and therapy should only be undertaken by practitioners that have received training and are deemed competent and confident.
A holistic and arterial assessment, Doppler or if not possible clinical signs, should be carried out prior to compression use. Consider co-morbidities, understanding, dexterity, skin fragility, concordance, tolerance, and safety. Those with an Ankle Brachial Pressure Index between 0.5-0.8 and with no other arterial signs may still be considered for compression.
Patients may require compression bandaging to reduce the oedema, heal wounds, stop lymphorrhoea leakage, and reshape limbs prior to compression hosiery or device use. Below knee compression will be the preference for most patients; however if the disease extends above the knee, thigh high should be considered.
Patients with compression treatments should be monitored, and adjustments made to the compression, e.g. size, type, class, correct positioning according to individual needs. This can be completed via a visit, an appointment or over the telephone, but face-to-face contact is recommended at a minimum of every 6 months, and should include a circulatory check. It is advised that compression hosiery be prescribed in 2 pairs every 6 months: one to wear, one to wash.
Some patients may benefit from wearing a form of compression only during waking hours, and others for 24 hours a day.
Advice can be sought from:
North Devon Lymphoedema Service Contact Details:
Northern Devon Healthcare NHS Trust
Tissue Viability Team Contact Details:
Northern Devon Healthcare NHS Trust
Royal Devon and Exeter NHS Foundation Trust
Compression hosiery comes in a multitude of shapes, sizes and classification testing standards, such as BS (British Standard), RAL (German Institute for Quality Assurance and Certification), and AFNOR (French national standard organisation).
Please ensure that when prescribing Compression Hosiery that consideration is given to the amount of compression you wish to achieve for your patient, regardless of classification. The below tables will act as a guide to support the right choice for the patient, and reduce potential prescribing errors.
|BS||Pressure Applied||Recommended Use|
|Class I||14 - 17 mmHg||Mild|
|Class II||18 - 24 mmHg||
Moderate - Severe
|RAL||Pressure Applied||Recommended Use|
|Class I||18 - 21 mmHg||Mild|
|Class II||23 - 32 mmHg||Moderate|
|Class III||34 - 46 mmHg||Moderate - Severe|
|Class IV||>49 mmHg||Severe|
In the RAL classification some companies may have an F or an S after the compression class e.g. Class 3F, this indicates a stiffer fabric.
CIRCULAR (ROUND) KNIT: the material is continuously knitted on a cylinder, has no seam, and is used mainly to make ready to wear garments. These garments may be thinner and more cosmetically acceptable than flat knit garments.
FLAT KNIT: these are knitted flat and joined by a seam. The material is firmer and thicker than circular knit; with most custom garments made this way. These are a good choice for shape distortion and skin crease to prevent cutting and causing skin trauma.
The ready to wear devices are as stated below but there are custom products available for those with measurements outside of the range. Consider the wide variety of sizes available in the formulary prior to prescribing made-to-measure.
Compression hosiery kits can be used for the treatment of venous and mixed aetiology leg ulcers. Hosiery kits are used for patients with ABPI above 0.8, unless under the guidance of a specialist.
Suitable for patients that have a degree of dexterity and can use an application device, or who have family who can help apply the hosiery on at least a twice-weekly basis.
No form of compression should be used without a full leg ulcer assessment, with Doppler, being undertaken.
Ensure that patients/carers understand the need for appropriate care of hosiery; for example different products may have different washing instructions.
These can reduce foot, lower leg, knee, or thigh oedema; and be used in the treatment of leg ulcers. They are an option if hosiery is not tolerated, dexterity and mobility are limited, there are donning and doffing hosiery problems, or thigh compression is required.
They may be cost-efficient in that wraps can reduce qualified input (time saving) and other resource costs (being machine washable and reusable). They may encourage independence and self-management and can be worn over compression hosiery to deliver additional compression. They provide low resting and high working pressures and can be worn day and night.
Toe caps provide compression for the prevention and reduction of toe swelling. They are ultra-thin and can be used under other bandage products.
To work effectively, compression hosiery (below knee, thigh high, and tights) must apply the right amount of pressure to the leg. This often means that the garments can be difficult to put on and take off. Donning and doffing aids reduce the amount of physical effort involved, which may increase compression use compliance and aid independence.
Household rubber gloves can be a cost efficient and simple aid for the application of compression hosiery. All the following products are available to be prescribed on FP10.