From the Guidelines
For patients with venous insufficiency, a minimum compression pressure of 20 to 30 mm Hg is recommended, with pressures of 30 to 40 mm Hg advised for more severe disease, as evidenced by the most recent study in 2023 1. When using compression therapy, it is essential to consider the type of compression device and the pressure gradient. The study found that negative graduated compression bandages, which exert higher pressures at the calf over the distal ankle, achieved improved ejection fraction in refluxing vessels and higher extrinsic pressures compared to graduated compression bandages 1. Key considerations for compression therapy include:
- Proper fitting and education to encourage adherence
- Use of inelastic compression, which has been shown to be more effective than elastic bandaging for wound healing 1
- Caution when using compression in patients with arterial anomalies, such as those with an ankle-brachial index <0.6, as revascularization may be necessary 1
- Regular replacement of compression stockings, typically every 3-6 months, to maintain effectiveness
- Combination of compression with leg elevation and regular exercise to enhance venous return and improve outcomes.
From the Research
Good Compression for Venous Insufficiency
- Compression therapy is a means to treat venous stasis, venous hypertension, and venous edema, with objectives to reduce the swollen limb to minimum size, maintain that size, and allow the patient to participate in the care of his limb whenever possible 2.
- Medical compression stockings are a standard, non-invasive treatment option for all venous and lymphatic diseases, with moderately robust evidence for their use in patients with venous symptoms and prevention and treatment of venous oedema 3.
- Graduated compression stockings are considered the basic treatment for chronic venous insufficiency (CVI) regardless of the patient's clinical classification, but treatment outcomes are often impaired by patients not wearing the stockings properly 4.
- Therapeutic compression stockings have been shown to be an effective treatment for CVI of the lower extremities, with statistically significant improvements in patient severity scores for lower extremity swelling, pain, skin discoloration, activity tolerance, depression, and sleeping problems after 1 and 16 months of treatment 5.
- Compression therapy is key to venous leg ulcer management, and nurses should be aware of the importance of starting patients on compression therapy as early as possible, as well as the potential benefits of venous assessment and endovenous correction of superficial venous incompetence 6.
Types of Compression Therapy
- Static compression
- Specialized compression pumps
- Manual lymphatic drainage
- Compression wraps
- Compression stockings
- Nonelastic devices
Importance of Adherence to Treatment
- Adherence to wearing graduated compression stockings is crucial for effective treatment of CVI, but non-adherence rates can be high due to various reasons such as financial constraints, pain, and ignorance of the need to wear them 4.