Compression: When and Why It May Be Necessary

Compression garments are used to prevent or control edema (leg swelling). They may be stockings, sleeves, panty hose or leotards, depending on the problem. The compression helps circulation by preventing pooling of fluid in the arms or legs. To get good results from compression garments, they need to fit well and must be used as prescribed every day. They may be removed at bedtime.

At certain times in life, for one reason or another, the body may retain fluid in a specific area such as the legs, arms, or abdomen. This swelling is referred to as edema. When one experiences a sudden onset of edema, pain or redness in a particular area, any of these may signal an acute situation requiring immediate medical attention. Most edema, however, occurs over a prolonged period, gradually getting worse. This is when compression therapy may be recommended by a health care provider as part of a treatment plan.

By definition, compression means to condense, squeeze or press together. In general, there are four situations when compression may be indicated.

• "Tired Legs" — This occurs when the legs feel "achy," especially at the end of the day, from prolonged standing or sitting.
• Varicose Veins — These are dilated, "ropey" veins in the legs, which may cause symptoms of tenderness, pain, burning and swelling.
• Chronic Venous Insufficiency (CVI) — This is a disorder in which there is a reduced ability of the veins to move the blood back to the heart.
• Lymphedema — This occurs when the body's lymphatic system, which carries the lymph fluid from the limb back into the body's circulation, is impaired, causing persistent swelling in the arm or leg.

Make sure your health care provider tells you exactly what compression intensity is required for your specific condition before you purchase your compression garments. He or she will give you a prescription, which you can then take to a medical supply store.

For "tired legs" and varicose veins, mild to moderate compression below the knee stockings may be very helpful. These stockings are widely available at local drug stores, pharmacies and medical supply stores, most often staffed with trained personnel to assist in obtaining the proper size and fit. They may also be purchased on the Internet. Stockings should be worn during the day and removed at bedtime.

For chronic venous insufficiency, compression treatment may range from the use of multi-layered leg wraps to low and high stretch bandages and higher compression below-knee stockings. These remedies all require a doctor's order. The higher compression (30-40 mmHg) below-knee stockings are also available or may be ordered from a local drug or medical supply store.

When someone is diagnosed with lymphedema, compression pumping may also be used to decrease the edema before a stocking is fit for the limb. A sleeve connected to a pump is placed on the swollen leg or legs. The fluid is then rhythmically massaged up the leg and eventually excreted by the body. The lymphedema pump is used on a daily basis and must be prescribed by a doctor. After pumping, compression stockings (in some cases, 40-50 mmHg pressure) are applied to maintain these results. Insurance companies may frequently assist with the cost of the lymphedema pump. A technique called Manual Lymph Drainage (MLD) may be used in conjunction with the pump or special stretch bandages. MLD is a light type of massage that stimulates rhythmic movement of the lymph vessels and their valves, which are located superficially in the skin. Trained and licensed personnel may perform this movement of "massaging" the lymph fluid out of a particular area to help decongest the edema. Patients or a family member can also be taught to perform this treatment at home in order to maintain the limb size.

Getting the Right Fit Is Important to Get the Best Results
Before getting measured for a compression garment, the patient should understand that it is important to make sure all the excess fluid is out of the limb. This may be done by using a compression pump and wearing wraps between pumping sessions until much of the edema is reduced. Sometimes, if the edema is mild, simply wearing a wrap and elevating the limb over-night can reduce the edema so that measurement is possible. When getting measured, the patient should go early in the morning so that the limb doesn't accumulate fluid. If the edema is severe, it may be necessary to wear a wrap on the limb to make sure that the edema stays down before the limb is measured.

Correct Use of Your Compression Garment
Follow the instructions from your health care provider when using compression garments. Whenever possible, put the compression garment on immediately in the morning after getting out of bed so that there will be less accumulation of additional fluid, which may make it difficult to put on the stocking later in the day. Do not sleep in compression garments unless instructed by a health care provider to do so, take the compression garment off just before going to bed. When bathing, remove the stockings and inspect the skin for areas of redness or other color changes. These may be signs that the compression garment does not fit correctly.

How to Put on Your Compression Garment
Compression garments are intended to fit tightly and learning how to use them properly can be frustrating in the beginning. Putting on the garment will may take some time and practice to put on correctly, so be patient when you first begin to use them on a daily basis. Rubber gloves, such as those used to wash dishes or specially made gloves by compression garment companies, may be helpful when applying the stockings. The rubber gloves make it easier to grip the material firmly and smooth out wrinkles. The rubber gloves also protect the compression garment from tears caused by fingernails or jewelry. If you get a tear or run in the garment, the garment will not give the compression that is necessary.

Some compression garments come with a slip-on aid to cover the foot and make it easier to get the garment over the foot and ankle. At first, it may even be difficult to maneuver the compression garment over your toes. Put the slip-on aid over the toes, and put the foot into compression garment. After the garment is on, pull off the slip-aid.

Gently pull the compression garment up the limb, smoothing the extra material while pulling. For custom garments, make sure the heel is in the correct position and the seams are straight. For thigh-high or higher fitting garments, standing up to continue pulling it over the knee, hips and waist may be easier.

Compression garments should be kept smooth, especially at the ankle or behind the knee. For garments which are knee-high and for thigh-high stockings, do not roll down the garment at the top. Do not fold the garment down if it seems too long. Use your gloves to smooth the fabric evenly along the limb. If you do not wear your compression garment for a day or two, it may be too difficult to get it on. If your limb swells too much and you cannot get the garment on because it is too tight, you should wrap the limb as instructed and contact your health care provider.

Removing the Compression Garment
Pull the garment off slowly. Pull it down so that the compression garment is inside out when it is removed.

Care of the Compression Garment
Wash the garment every other day with a mild soap. Do not use Woolite™. Use warm water and wash by hand or use the gentle cycle in the washing machine. After rinsing the compression garment completely, remove excess water by rolling it in a towel. You can either air-dry the garment or dry on "cool" in the dryer on the delicate cycle. It may be convenient to have two compression garments. Order the second garment after establishing the proper fit.

Most importantly, be consistent when wearing the compression garment and replace it on a regular basis over time because the garment will lose its elasticity and therefore its effectiveness. Compression garments are good for about four to six months if they are cared for properly. A prescription for a compression garment is good for one year. You may need to be re-measured every year, especially if you have gained or lost weight greater than 15 pounds. Further questions about compression garments should be directed to a health care provider.

Compression therapies may be helpful and often necessary for treating swelling in the legs. In addition, daily leg elevation, walking and exercise programs such as swimming, are all excellent ways to improve circulation and prevent complications detrimental to your health and well-being.

About the Authors:
Peggy Began, RN/BSN, is a clinical nurse at the Cleveland Clinic Foundation, Dept. of cardiovascular medicine, specializing in wound care.

Cindy Felty, MSN, RN, CNP, CWS, is an adult nurse practitioner and assistant professor of medicine at the Mayo Clinic's Gonda Vascular Center.