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17.9 Compression hosiery and garments
All patients should be offered an Ankle Brachial Pressure Index (ABPI) assessment prior to commencement of any compression therapy, using a Doppler, by a clinician who has had the appropriate training. Applying a compression bandage to a limb that has arterial insufficiency could lead to pressure damage, limb ischaemia, and even amputation.
Before elastic hosiery can be dispensed, the product (including accessories), the length, quantity (single or pair), compression class, knit (circular or flat), and manufacturer must be specified by the prescriber.
Below knee stockings should be prescribed for all patients unless it is clearly indicated that thigh length would be of additional benefit.
For patients experiencing difficulty putting on class 3 hosiery, wearing a class 1 plus a class 2 stocking will provide the same level of support.
Occasionally, ready-made stockings are not suitable and custom-made stockings will be required, specific to the patient's individual measurements. Made-to-measure stocking sizes may be required due to irregular limb dimensions or if a correctly sized ready-made stocking cannot be obtained from leg measurements.
Made to measure hosiery and garments are for specialist prescribing only – consider the wide variety of sizes available in the formulary prior to referral for specialist assessment. State 'made to measure' on the prescription.
It is advised that compression hosiery be prescribed in 2 pairs every 6 to 12 months; one to wear, one to wash, as appropriate for type, frequency of change, and wear conditions.
Classification of compression hosiery
Compression hosiery comes in a multitude of shapes, sizes and classification testing standards, such as BS (British Standard), RAL (German Institute for Quality Assurance and Certification), and AFNOR (French national standard organisation)
Please ensure that when prescribing Compression Hosiery that consideration is given to the amount of compression you wish to achieve for your patient, regardless of classification. The below tables will act as a guide to support the right choice for the patient, and reduce potential prescribing errors.
| BS |
Pressure Applied |
Recommended Use |
| Class I | 14 - 17 mmHg | Varicose veins, mild oedema |
| Class II | 18 - 24 mmHg | Moderate / severe varicose veins, prevention of ulcer recurrence |
| Class III | 25 - 35 mmHg | Gross varices, post-phlebitic limb, leg ulcer recurrence, lymphoedema |
| RAL |
Pressure Applied |
Recommended Use |
| Class I | 18 - 21 mmHg | Minor varicose veins, early varices during pregnancy, not suitable for oedema |
| Class II | 23 - 32 mmHg |
Varicose veins with oedema, post-traumatic swelling,
significant varicose veins during pregnancy |
| Class III | 34 - 46 mmHg |
Chronic venous insufficiency, secondary varicose veins,
extensive oedema, recurrence |
| Class IV | >40 mmHg | Lymphoedema |
Flat and circular knit
There are two methods of making compression hosiery/garments:
Circular knit garments have no seams. The knit is fine and garments are soft and stretchy making application easier. Circular knit garments may be particularly useful for low risk patients who develop oedema as a result of a range of venous conditions. This type of hosiery may cause the development of tight bands around the oedematous region, especially in patients with soft pitting oedema. However, patients who are concerned about the appearance of the garment may prefer the sheer look of these. Unisex compression socks may help with patient concordance.
Flat knit garments have a seam and are usually made to measure. These are available in unlimited shapes and sizes. They are particularly useful for patients with unusual shaped limbs and lymphoedema / lympho-venous disease. They are made up from inelastic fibres and control chronic oedema by their stiffness. They may be recommended for chronic oedema / lymphoedema due to their positive effect on lymphatics (firm compression hosiery / garments move the fluid through the tissue spaces, increasing lymph reabsorption and stimulation of the lymphatics).
- Compression hosiery can be slept in if preferred, up to a maximum of 7 days (NICE CKS Compression stockings (September 2012)). This is particularly beneficial for patient with impaired dexterity
- Patients should be shown how to apply compression hosiery and garments, and offered hosiery applicators to aid application and reduce risk of trauma when applying
- It should be noted that while compression hosiery is extremely effective when being worn it does not repair damaged valves or vein walls. Consider vascular referral for eligibility for corrective surgery / schlerotherapy.
Compression hosiery
Duomed Soft
- Compression hosiery (from £14.75) (one pair)
- British Standard Class I (14-17 mmHg)
- Circular knit
- Below knee, Sand or Black, Closed or Open toe
- Sizes Small to XXLarge
Notes
- To be used as a liner to aid application or light compression
- Clinical effectiveness of 3 months daily use
Mediven Plus (Open toe)
- Compression hosiery (range between £31.52 to £63.05) (one pair)
- RAL Class I (18-21 mmHg), Class II (23-32 mmHg)
- Circular knit
- Below knee or Thigh length, Beige or Black
- Sizes I, II, III, IV, V, VI, VII
- Regular or Petite leg length
Notes
- Extra wide variants, waist attachments, and silicone top bands available
- Clinical effectiveness of 6 months daily use
Mediven Elegance (Closed toe)
- Compression hosiery (range between £31.30 to £60.94) (one pair)
- RAL Class I (18-21 mmHg), Class II (23-32 mmHg)
- Circular knit
- Below knee, Thigh length or Tights, Beige or Black
- Sizes I, II, III, IV, V, VI, VII
- Regular or Petite leg length
Notes
- Extra wide variants, silicone top bands available
- Clinical effectiveness of 6 months daily use
Mediven Active
- Compression socks (from £31.02) (one pair)
- RAL Class I (18-21 mmHg), Class II (23-32 mmHg)
- Circular knit
- Below knee, Grey, Navy, Black, Brown, or White, Closed toe
- Sizes I, II, III, IV, V, VI, VII
- Regular or Petite leg length
Notes
- Unisex sport sock
- Fits UK shoe sizes 5 to 12.5
- Clinical effectiveness of 6 months daily use
Mediven for Men
- Compression socks (from £31.06) (one pair)
- RAL Class I (18-21 mmHg), Class II (23-32 mmHg)
- Circular knit
- Below knee, Grey, Navy, Black, Closed toe
- Sizes I, II, III, IV, V, VI, VII
- Regular or Petite leg length
Notes
- Ultra-modern ribbed office sock
- Fits UK shoe sizes 3 to 11
- Clinical effectiveness of 6 months daily use
Sigvaris Essential Thermoregulating
- Compression hosiery (from £29.45) (one pair)
- RAL Class I (18-21 mmHg), Class II (23-32 mmHg), Class III (34-46 mmHg)
- Circular knit
- Below knee, Thigh length or Tights, Nature or Black, Closed or Open toe
- Sizes XXSmall to XLarge Plus
- Short, Normal or Long leg length
Notes
- For use in patients with skin sensitivities
- Waist attachments and grip tops available
- Clinical effectiveness of 6 months daily use
Made to measure hosiery and garments are for specialist prescribing only – consider the wide variety of sizes available in the formulary prior to referral for specialist assessment. State 'made to measure' on the prescription.
Mediven Mondi Made to Measure
- Patient specific Made to Measure compression hosiery (from £37.14) (one pair)
- RAL Class I (18-21 mmHg), Class II (23-32 mmHg), Class III (34-46 mmHg)
- Flat knit
- Available in various lengths and colours (4 standard and nine trend colours)
Notes
- Clinical effectiveness of 6 months daily use
- Mediven Mondi Made to Measure order/measure form
Sigvaris Essential Thermoregulating Made to Measure
- Patient specific Made to Measure compression hosiery (from £35.28) (one pair)
- RAL Class I (18-21 mmHg), Class II (23-32 mmHg), Class III (34-46 mmHg)
- Circular knit
- Available in various lengths
Notes
- Clinical effectiveness of 6 months daily use
- Sigvaris Essential Thermoregulating Made to Measure order/measure form
Guidelines for the use of treatment hosiery (ulcer/hosiery kits)
40mmHg compression at the ankle
Leg ulcer hosiery treatment kits, give compression bandage patients a hosiery alternative. Colloquially called Class 4, it has been designed to provide an alternative to standard 4-layer bandaging, with a use in maintenance therapy when higher compression levels are required.
No form of compression should be used without a full leg ulcer assessment, with Doppler, being undertaken.
Mainly for use for those patients with an Ankle Brachial Pressure Index (ABPI) of above 0.8 they could be considered for individuals with a slightly lower ABPI providing there are no other arterial signs. They can be used to facilitate healing in patients with normal shaped limbs and minimal oedema. However, advice should be sought from Tissue Viability.
Consideration needs to be given to the length of the leg if using a stocking that does not specify short or long. Take care when ordering to specify size and, where appropriate, length.
Choose patients that have a degree of dexterity and can use an application device or who have family who can help apply the hosiery on at least a twice-weekly basis.
Ensure that patients/carers understand the need for appropriate care of hosiery. Products may have different washing instructions; ensure that patients are aware of specific recommendations for the selected product.
These hosiery can be used for patients who continually have recurrent leg ulcers, and may offer improvements in ease of application.
Ulcer kit
Mediven Ulcer Kit
- Ulcer kit (pack contains 1 Mediven stocking, 2 liners, and 1 easy-on applicator) (£35.32)
- RAL Class IV (>40 mmHg) (Liner 20 mmHg / Outer 20 mmHg)
- Circular knit
- Sizes I, II, III, IV, V, VI, VII
- Standard or Petite leg length
- Liner pack (pack contains 2 liners) (£18.76)
Notes
- Can be ordered as a kit or as individual components
- Clinical effectiveness of 6 months daily use
- Mediven Ulcer Kit order/measure form
JOBST UlcerCARE (Ready-to-Wear)
- Ulcer kit (pack contains 1 stocking and 2 liners, zip or no zip) (£34.09)
- RAL Class IV (>40 mmHg) (Liner 17mmHg / Outer 23mmHg)
- Flat knit
- Sizes Small to XXXXLarge
- Beige and Black
- Liner pack (pack contains 3 liners) (£20.58)
Notes
- Can be ordered as a kit or as individual components
- Clinical effectiveness of 6 months daily use
- Jobst UlcerCARE Ready-to-Wear order/measure form
JOBST UlcerCARE (Custom-Fit)
- Made-to-measure ulcer kit (£69.08)
- RAL Class IV (>40 mmHg) (Liner 17mmHg / Outer 23mmHg)
- Flat knit
- Caramel and Black
- Liner pack (pack contains 2 liners) (£34.54)
Notes
- Liners can be ordered as individual components
- Clinical effectiveness of 6 months daily use
- Jobst UlcerCARE Custom-Fit order/measure form
As with other compression, holistic leg ulcer assessment, with Doppler and ABPI calculation, must be performed prior to use.
Specialist use only, consider referral to Tissue Viability for advice about fitting with Juxta CURES or Juxta Fit if unable to manage ulceration or oedema with compression bandaging or treatment hosiery. This garment may also be suitable for patients who wish to be self-caring but have moderate to high exudate levels or require some leg reshaping.
Juxta CURES
- Compression system (£168.55)
Notes
- Juxta CURES is an instantly adjustable compression system for the treatment of venous stasis ulcers and is an alternative to compression bandaging and treatment hosiery.
- Juxta CURES is suitable for many venous leg ulcer patients. Benefits include: reduced nursing time, promotes patient self-management, aids healing and reduces treatment costs. Particularly useful if regular foot inspection is required. This product can be used with padding, to enable leg reshaping.
Juxta FIT
- Compression system (£143.15-£147.72)
Notes
- The Juxta-Fit Lower Legging is an inelastic, adjustable compression garment for the management of lymphoedema / lymphovenous disease. It is available in two lengths, petite (28cm) and standard (36cm) and five sizes ranging from small to XXL. Garments are also available for the knee, upper leg and foot.
- Features: effective self-care, graduated profile, alternating band system for easy application, minimal adjustments, low resting pressure, high working pressure.
- Latex free.
Haddenham Microfine Toe Cap
- Compression garment (£29.09) (one)
- AFNOR Class III (20-36 mmHg)
- Sizes XSmall to XLarge
- Sand or Black
Jobst Elvarex Plus Foot Cap
- Made to Measure Compression Garment (£46.95-£48.88) (one)
- RAL Class I (18-21 mmHg), Class II (23-32 mmHg), Class III (34-46 mmHg)
- Flat knit
- Beige, Blue, Brown, Cranberry, Black, Grey
Indication
- Chronic oedema / Lymphoedema
Notes
- Foot cap available with either 4 or 5 toes
- Jobst Elvarex Plus Foot Cap order/measure form
Hosiery applicators are designed to make it easier to apply and remove compression garments, with minimal to no disruption to limbs, especially for those with mobility problems.
Juzo Easy Fit
- For all stocking lengths
- For Closed or Open toes
Sigvaris Rolly
- For all stocking lengths
- For Closed or Open toes
- Flexible elastic membrane filled with water
- Small and light
Urgo Sockaid
- For Closed or Open toes
- Lightweight and robust
- Metal framed appliance
Ezy-As
- Small, Medium and Large sizes
- For Closed or Open toes
- Rigid applicator
- Universal Handle attachment available
Medi 2in1
- For all stocking lengths
- For Closed or Open toes
- Soft but hard wearing applicator
- Light and very compact
