What type of compression stocking is recommended for a patient with venous insufficiency or lymphedema?

Compression Stocking Order for Venous Insufficiency and Lymphedema

For patients with venous insufficiency or lymphedema, compression stockings with 30-40 mmHg pressure are recommended as first-line therapy, with graduated compression that exerts higher pressure at the ankle and gradually decreases up the leg. 1

Compression Pressure Selection

• Mild disease (C2-C3 CEAP classification): 20-30 mmHg pressure
• Moderate to severe disease (C4-C6 CEAP classification): 30-40 mmHg pressure 1
• Lymphedema: 30-40 mmHg pressure, with consideration for custom-fitted stockings in cases of severe or irregularly shaped limbs 2

Stocking Length Selection

• Below-knee stockings: Sufficient for most patients with venous insufficiency affecting the lower leg
• Thigh-high stockings: Consider for patients with proximal venous insufficiency or edema extending above the knee
• Pantyhose/waist-high stockings: For bilateral disease or when thigh-high stockings tend to roll down 1, 2

Specific Ordering Parameters

1. Compression level:

   • 30-40 mmHg for moderate to severe venous insufficiency or lymphedema
   • 20-30 mmHg for mild disease or patients who cannot tolerate higher compression

2. Style:

   • Below-knee (most common and best tolerated)
   • Thigh-high with silicone band (for proximal disease)
   • Pantyhose/waist-high (for bilateral disease)

3. Quantity: 2 pairs (allows for washing/rotation)

4. Material considerations:

   • Consider stockings with integrated skin care for patients with dry skin to improve compliance 3
   • Custom-fitted stockings should be considered for patients with unusual leg dimensions or severe lymphedema 4

Wearing Instructions

• Apply in the morning before getting out of bed when edema is minimal
• Wear daily for at least 11 hours per day 5
• Continue use for the duration of treatment (typically long-term for chronic conditions)
• Remove at night while sleeping

Important Clinical Considerations

• Contraindications: Severe peripheral arterial disease (ankle-brachial index <0.6), acute deep vein thrombosis, severe heart failure, skin infections 1, 6
• Measurement: Accurate leg measurements are essential for proper fit and effectiveness
• Patient education: Proper donning/doffing techniques and skin care are critical for compliance 5
• Reassessment: Evaluate fit and effectiveness at 1-3 month intervals
• Replacement: Stockings typically need replacement every 3-6 months as they lose elasticity

Special Situations

• Patients with difficulty donning stockings: Consider prescribing donning aids
• Patients with skin sensitivity: Stockings with integrated skin care show better outcomes for skin moisture and reduced roughness 3
• Patients with severe or irregularly shaped limbs: Custom-fitted stockings show superior quality of life outcomes and better compliance compared to standard stockings 4

Compression therapy remains the cornerstone of treatment for venous insufficiency and lymphedema, with high-quality evidence supporting its use for symptom management, edema reduction, and ulcer prevention and treatment 1, 2.