Long-Term Care

Graduated compression stockings

LTC Nursing Assistant Trainer, April 19, 2012

Graduated compression stockings (GCS) have been used effectively for years to prevent deep venous thrombosis (DVT) in hospitalized patients. They are also common in long-term care facilities, and are worn by many persons living in the community.

The hosiery provides graduated pressure, and is tightest at the ankle, becoming progressively looser as it extends up the proximal leg. The hosiery increases blood flow velocity and improves valve function. The increased speed reduces the risk of venous stasis and pooling. GCS compress superficial veins and capillaries, which redirects blood to the deeper, larger veins, where it flows effortlessly to the heart. This reduces venous hypertension and decreases the risk of stagnation. The controlled compression of the skin provides additional support for the venous system, reducing edema and promoting venous return from the ankles and calves.
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Although GCS are believed to be a low-tech, low-risk treatment, they are not risk-free. Patients with diabetes, neuropathy, connective tissue diseases, signs of clinical infection in the extremity, and peripheral vascular disease have an increased risk of complications. Contraindications for GCS use include:

  • Severe arteriosclerosis or other ischemic vascular disease
  • Pulmonary edema, congestive heart failure
  • Massive leg edema
  • Local conditions such as dermatitis, postoperative vein ligation, recent skin graft, and gangrene
  • Deformity of leg
  • Circumference greater than 25 inches (63.5 cm) at the gluteal fold, if thigh-high hose are ordered

Potentially serious complications resulting from GCS use include:

  • Reduced blood flow and tissue oxygenation
  • Pressure ulcers
  • Arterial occlusion
  • Thrombosis
  • Gangrene

Complications are usually associated with hosiery that do not fit properly, failure to remove the stockings for skin and circulation checks, and folding and bunching up of hosiery, causing a tourniquet effect to the skin.

This is an excerpt from the HCPro book, The Long-Term Care Nursing Desk Reference, Second Edition, by Barbara Acello, MS, RN.

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