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Compression Stockings

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Compression Stockings, Elastic Support Garment, Compression Legging, Support Hose, Antiembolic Stocking, Compression Sock, Thrombo-Embolic Deterrant Stocking, T.E.D. Hose, Jobst Stocking

  • Indications
  1. Lymphedema
  2. Chronic Venous Insufficiency
  • Contraindications
  1. Significant Peripheral Arterial Disease (Ankle brachial index <0.8)
  2. Peripheral Neuropathy
  3. Skin Infections
  • Technique
  1. Pressure should increase distally from knee to ankle (Graduated)
  2. Wear stockings throughout day (remove at night)
  3. Apply stockings in the morning before swelling starts to increase
  4. Avoid OTC low pressure stockings for DVT Prevention
  5. Knee length stockings are more comfortable and as effective as thigh length
  6. Smooth-out stockings and avoid the stocking bunching-up on application
  7. Allow any Topical Lotions to dry before applying stockings
  8. Consider applying talc before applying stocking
  9. Stocking application Assistive Devices are available (e.g. stocking butler, stocking donner)
  10. Non-custom stockings as effective as Custom stockings
    1. However, proper measurements from a certified fitter (e.g. Medical Supply Store or Pharmacy) is recommended
  • Dosing
  1. Mild Compression (<20 mmHg): Non-Medical Grade OTC
    1. Not generally recommended due to low efficacy
    2. Includes most T.E.D. Hose and OTC Compression Socks
    3. Does not prevent DVT
    4. May reduce venous pooling in patients on their feet throughout the day, but minimally effective
  2. Medium Compression (20-40 mmHg): Medical Grade
    1. Stockings for Venous Insufficiency and Venous Ulcers
    2. May also reduce DVT Risk on prolonged airplane flights
    3. May decrease pain in Post-Thrombotic Syndrome
  3. High Compression (>40 mmHg)
    1. Severe Venous Insufficiency
    2. Chronic Lymphedema
  • Preparations
  1. Anti-embolism stockings (e.g. TED stockings)
    1. Pressure: 8-10 mmHg
  2. Elasticized tubular gauze (e.g. Tubigrip)
    1. Pressure: 15-20 mmHg
    2. Indications
      1. Older patients with Venous Insufficiency
  3. Single layer elastic wrap (e.g. ACE Wrap)
    1. Pressure: 20 mmHg
  4. Compression Stockings (e.g. Jobst, Juzo)
    1. Pressure: 30-40 mmHg
    2. Indications
      1. Severe Venous Insufficiency or Lymphedema
    3. Custom Jobst Stockings
      1. Based on circumference at every 1.5 inches up leg
      2. Indications
        1. Large calf with narrow ankle (risk of Tourniquet)
        2. Lipodermatosclerosis
  5. Multi-layer compression Wraps (e.g. Dynaflex)
    1. Pressure: 30-40 mmHg
    2. Indications
      1. Severe Venous Insufficiency or Lymphedema
  • Coding
  1. HCPCS: L8100
  • References
  1. (2019) Presc Lett 26(10): 56