Recommended mmHg for Compression Stockings
For most clinical applications, compression stockings should be prescribed at 20-30 mmHg pressure for mild to moderate conditions, while 30-40 mmHg is recommended for more severe venous disease. 1
Compression Pressure Recommendations by Clinical Condition
General Recommendations:
- Mild to moderate conditions: 20-30 mmHg (minimum effective pressure) 1
- Severe venous disease: 30-40 mmHg 1, 2
Specific Clinical Scenarios:
Venous Leg Ulcers:
- 30-40 mmHg inelastic compression is superior to elastic bandaging for wound healing 1
- For patients with ankle-brachial indices between 0.9-0.6, reduced compression of 20-30 mmHg is effective and safe 1
- Caution: Do not use compression when ankle-brachial index is <0.6 due to risk of arterial compromise 1
Post-Thrombotic Syndrome:
- 30-40 mmHg elastic compression stockings are recommended as first-line treatment 2
- Should be worn daily for 8-12 hours per day 2
Long Flights/DVT Prevention:
- 20-30 mmHg below-knee compression stockings are effective for preventing DVT during long flights 1
Pediatric Patients with Symptomatic PTS:
- Lower pressure of 15-20 mmHg is recommended to start, worn 8-12 hours daily for at least 3 days per week 1
Physiological Effects of Different Compression Levels
- 20 mmHg: Sufficient to increase venous blood flow velocity in supine position and prevent leg swelling after prolonged sitting/standing 3
- >50 mmHg: Required in upright position for intermittent occlusion of incompetent veins and reduction of ambulatory venous hypertension during walking 3
- >60 mmHg: May be counterproductive for lower extremity edema reduction 4
- >30 mmHg: May be counterproductive for upper extremity edema reduction 4
Important Clinical Considerations
Compression Effectiveness by Position:
- Standard 20-30 mmHg compression stockings effectively compress both superficial and deep veins when the patient is supine
- However, they may not effectively compress veins when the patient is standing 5
Application Techniques:
- Proper fitting is essential - stockings that are too tight can prevent essential venous return and potentially cause ulceration 1
- Pressure indicators on bandages or adaptive bandages with templates can help ensure correct application pressure 6
Common Pitfalls:
- Incorrect sizing: Stockings that are too tight can cut into skin and potentially increase DVT risk 1
- Poor patient compliance: Often due to difficulty applying stockings or discomfort 1
- Inadequate pressure: Many compression bandages are applied too loosely to achieve therapeutic effect 6
- Overlooking arterial disease: Always check ankle-brachial index before prescribing compression for patients with risk factors for peripheral arterial disease 1
By selecting the appropriate compression level based on the clinical condition and ensuring proper fitting and patient education, compression therapy can effectively manage various venous and lymphatic conditions.