What is the recommended compression level and management for a patient requiring low-grade compression stockings?

From the Guidelines

Low-grade compression stockings with a pressure of 15-20 mmHg are recommended for patients with mild venous insufficiency, early varicose veins, mild edema, or for prevention of deep vein thrombosis during travel or prolonged sitting. The management of patients requiring low-grade compression stockings involves several key considerations, including:

• Proper fit, with measurements taken early in the day when legs are least swollen, including ankle circumference, calf circumference, and leg length from floor to knee or groin depending on stocking length 1
• Stockings should be replaced every 3-6 months as they lose elasticity with regular washing and wearing
• Patients should have at least two pairs to alternate daily
• Proper application involves turning the stocking inside out up to the heel, placing the foot in, and gradually rolling the stocking up the leg without bunching
• The stockings work by applying graduated pressure, strongest at the ankle and decreasing up the leg, which helps improve venous return by pushing blood upward against gravity, reducing pooling and swelling Some studies have shown that compression stockings can reduce the incidence and severity of postthrombotic syndrome among patients wearing compression stockings, either over-the-counter stockings or custom-fit stockings, if use was initiated within 1 month diagnosis of proximal DVT 1. However, the most recent and highest quality study, 1, provides the most relevant evidence for the management of patients requiring low-grade compression stockings. Key points to consider when prescribing low-grade compression stockings include:
• The compression strength was 20-30 mm Hg at the ankle in four trials and 10-20 mm Hg in the other four trials 1
• Stockings come in different sizes and should be fitted properly to avoid preventing essential venous return or causing ulceration and increased risk of DVT
• Patients should wear stockings around the house prior to travel to ensure a good, comfortable fitting
• Stockings were put on 2 to 3 h before the flight in most of the trials 1.

From the Research

Prescription for Low-Grade Compression Stockings

To manage a patient requiring low-grade compression stockings, the following guidelines can be considered:

• The recommended compression level for low-grade compression stockings is typically in the range of 8-15 mmHg or 15-20 mmHg 2, 3.
• The management of patients with low-grade compression stockings involves the use of graduated elastic compression (GEC) stockings to reduce reflux and venous volume, and to enhance venous return 2.
• The application of low-grade compression stockings can be effective in achieving a reduction in venous dilation and venous pooling, and improving venous return in the lower extremities 3.
• The choice of compression level and type of stocking depends on the individual patient's needs and the specific condition being treated, such as venous symptoms, prevention and treatment of venous oedema, or lymphoedema management 4.

Key Considerations

• The use of commercial support hose may be contraindicated in patients with evidence of venous disease in the lower extremity, as it may worsen venous return 5.
• The efficacy of compression stockings in preventing vasovagal syncope recurrences is being investigated in clinical trials, with promising results 6.
• It is essential to assess the individual patient's response to compression stockings and adjust the prescription accordingly, taking into account factors such as age, venous disease status, and lifestyle 2, 3, 5.