Hosiery

Overview

Refer to BNSSG CCG Guidelines on the use of Leg Compression Hosiery for information on:

• Indications for use
• Contraindications/cautions in use
• Patient assessment prior to prescribing
• Prescribing hosiery and the BNSSG leg compression formulary
• Patient review/follow up

Do not prescribe compression hosiery for the sole prevention of DVT for travellers as this is not available on NHS prescription. Patients should be advised to purchase Class 1 below knee stockings or flight socks.

Measuring and Selecting the correct hosiery

Measuring and selecting the correct size of hosiery 

The usefulness of the garment is dependent on the accuracy of limb measurements and the correct selection of garment based on those measurements. Size selection is usually undertaken by community pharmacists or appliance contractors. In 95% of cases measurements are likely to fall within the manufacturer‘s standard size garments.

The prescriber, or practice nurse, will usually measure the person's leg(s) so that the correct size of stocking can be determined from the manufacturers' sizing charts (see below for links). Write the measurements on the prescription. If these are not stated on the prescription, some pharmacists may carry out the measurements for compression hosiery if the person can attend the pharmacy. If this is not possible, they will either ask the person or carer to do the measurements (if capable) or refer the person back to the GP practice nurse. If the patient has already been measured within the last six months and the correct size to prescribe is known, this should be written on the prescription and the hosiery must be prescribed by brand. Note that community pharmacies are unable to measure patients who require compression wraps because this requires specialist measurement which should be undertaken by a lymphoedema nurse specialist.

The measurements that need to be taken vary depending on the manufacturer, but in general the following need to be obtained for below-knee stockings (taken with the person seated, and feet flat on the floor):

• Around the ankle, at the narrowest point just above the ankle bone (malleoli).
• Around the widest part of the calf (usually the mid-calf area).
• From the heel to the tip of the longest toe (if a closed-toe stocking is required).
• If a thigh-length stocking is prescribed, also measure around the widest part of the thigh and from the heel to the buttock fold while the person is standing.
• If the person has a swollen leg, measurements should be taken first thing in the morning. This may require a visit by a community nurse if the patient is housebound.

Made-to-measure hosiery

Where measurements are significantly different to standard size documents, made-to-measure garments should be prescribed. Patients who may need these include patients with:

• Large feet
• Grossly oedematous legs
• Awkward Shaped Legs
• Wide malleoli measurement 

Standards and classes of compression stockings

Additional considerations

When prescribing for DVT:

• Prescribe patients with proximal DVT for Class 2 below-knee graduated compression stockings (ankle pressure >23 mmHg (RAL standard)) and review 1 week after diagnosis to allow the resolution of acute swelling
• Stockings should be worn for at least 2 years and replaced 2-3 times / year

Suspender belts - Men prescribed thigh-length garments may be prescribed a suspender belt but women are ineligible for a suspender belt on NHS prescription.

Product/measuring information

Hosiery Guide 2020 - Medi products

Product guide & measuring charts - Medi products (Mediven^®, Duomed Soft^®)

Measuring guides and order forms - JOBST products (All)

Measuring charts and order forms - L&R products (Activa^®, ActiLymph^®) 

Fitting and Removing Hosiery

Hosiery should be fitted without creases or wrinkles. The garment should be fitted next to the skin. If required, the leg may be lightly coated with powder. The patient should remove all sharp objects (e.g. rings and bracelets) and trim long nails on fingers and toes. The garment should be turned inside-out as far as the heel pouch. The heel should be laid flat so that the foot may slip in easily and the toes and heel be correctly positioned. The rest of the garment should be eased over the foot and ankle, ensuring it does not become bunched. The garment may then be gently pulled up the leg, but care should be taken not to damage the garment with fingers or nails. Where application remains an issue, application aids are available on prescription which are effective in applying hosiery.

Removing hosiery is usually easier than putting it on. The garment should be peeled down as far as the ankle, in effect turning it inside-out. It can then be removed from the leg by pulling the toe portion gently. Compression stockings should be removed at bedtime, although if impossible, wear time can be extended to a maximum of 7 days.

Patient review

Nurse review of patient every three to six months to:

• Reassess the condition for which the stocking is being prescribed
• Ensure that the person is continuing to wear the stocking successfully and is replacing them regularly
• Repeat leg measurements to ensure that the stocking continues to be the correct size

Care of Hosiery

Refer to manufacturer’s instructions for care of hosiery. Hosiery with ladders or holes should be discarded. Provide at least two stockings (or two pairs if used on both legs), so that one can be worn while the other is being washed and dried. Review patient every six months to ensure correct fit.

Resources

NICE Clinical Knowledge Services (CKS)

• DVT Management
• Compression stockings
• Venous leg ulcers
• Venous eczema and lipodermatosclerosis
• Superficial vein thrombosis (superficial thrombophlebitis)

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.