Chronic Venous Insufficiency in A Selected Nurse Population: A Cross-Sectional Study

Chronic venous insufficiency (CVI) causes severe symptoms and complications in the general population, but the prevalence, related risk factors, and treatment of CVI are unknown among nurses. The demographics and occupational factors of nurses from a university hospital were collected by questionnaires, and the presentation of CVI was confirmed by the specialist vascular surgeons. A total of 1606 participants were enrolled, and the prevalence of CVI was 7.5%. After multivariate adjustment, CVI was positively related to deep venous thrombosis history (OR 6.44, 95% CI 2.73-15.22), increased standing time (OR 2.21, 95% CI 1.20-4.10), and increased time in night shift rotation (OR 2.01, 95% CI 1.29-3.14). CVI was negatively related to oral contraceptives (OR .43, 95% CI .21-.87). Of the participants, 72.5% with CVI received compression therapy. For them, wearing compression stockings with a pressure of >20 mmHg or for >4 h/day significantly increased the rate of symptom relief, while the length of compression stockings made no difference. Thus, it was beneficial for nurses to spend less time standing and shorten their time in night shift rotation. Wearing compression stockings with sufficient pressure and for enough time was recommended for CVI symptom relief.

Effects of Compression Stockings on Body Balance in Hemiplegic Patients with Subacute Stroke

(1) Background: Stroke patients with hemiplegia have an increased risk of developing deep vein thrombosis (DVT). DVT increases the risk of life-threatening pulmonary embolism and is associated with poor prognosis. The early wearing of compression stockings can help prevent DVT. This study aimed to assess the impact of compression stockings on body balance in stroke patients with unilateral lower extremity muscle weakness; (2) Methods: Hemiplegic stroke patients in the subacute phase who were able to walk with assistance were recruited. The patients were divided into two groups: one group received rehabilitation treatment with compression stockings, and the other received treatment without compression stockings. The rehabilitation treatment involved hospitalization for 4 weeks, the Trunk Control Test (TCT), the Trunk Impairment Scale (TIS), and the Berg Balance Scale (BBS). The patients were evaluated before and 4 weeks after the start of treatment. The differences in BBS, TCT, and TIS before and after treatment between the two groups were compared; (3) Results: Altogether, 236 hemiplegic stroke patients were recruited. There was an improvement in body balance after treatment in both groups, and BBS, TCT, and TIS scores significantly increased in the group that received rehabilitation treatment with compression stockings; (4) Conclusions: In patients with hemiplegic stroke in the subacute period, rehabilitation while wearing compression stockings appears to improve body balance.

The Structure and Compression of Medical Compression Stockings

This paper lays out standards of compression stockings and their classification into classes. The analysis of knitted fabric structure parameters, elongation and compression of moderate- and high-compression stockings was conducted. Stocking compression on specific parts of the stocking leg was measured on three sizes of a wooden leg model. For moderate-compression stockings, compression above the ankle was 32 hPa. For high-compression stockings, compression above the ankle was 60 hPa. Both groups of the analyzed compression stockings were made on modern one-cylinder hosiery automats. The legs of the stockings were made in single inlaid jersey 1 + 1. Both yarns were elastane covered. The finer yarn formed loops and its knitting into a course was significantly larger than in the other yarn, which was much coarser and does not form loops but “lay the weft in a bent way”. The smallest elongation of knitted fabric was above the ankle, where the highest compression was achieved, while the largest elongation was under the crotch, where the stocking leg exerted the smallest compression on the surface. The leg of the compression stocking acted as a casing that imposed compression on the leg and often reinforced it to be able to sustain compression loads.

Compression stocking prevents increased venous retrograde flow time in the lower limbs of pregnant women

OBJECTIVES

To analyze the effect of graduated compression stockings on the venous reflux in the lower limbs of pregnant women.

METHOD

A controlled randomized clinical trial was performed with sixty women: intervention group (n = 30), who used compression stockings, and control group (n = 30). Using duplex-ultrasound, the reflux time and peak reflux velocity in the great saphenous vein and small saphenous vein were analyzed.

RESULTS

Great saphenous vein reflux times in the intervention group were 0.13 s at the beginning (initial) and 0.04 s at the end of pregnancy (final) in the right leg and 0.02 s and 0.34 s (p < 0.0001) in the control group. No patient in the intervention group experienced pathological reflux at the end of the pregnancy. There was a significant difference in the reflux time measured from both the great saphenous vein and small saphenous vein and peak reflux velocity between the groups.

CONCLUSION

Compression stockings prevent increased venous reflux in lower limbs of pregnant women.

Graduated compression stockings effects on chronic venous disease signs and symptoms during pregnancy

Objectives

To evaluate the effectiveness of compression stockings in controlling the varicose veins in pregnant women.

Method

A prospective controlled randomized clinical trial was performed, including 60 women: intervention group (n = 30), who used compression stockings, and control group (n = 30). Diameters of the great saphenous vein and small saphenous vein in the lower limbs of pregnant women in an orthostatic position were analyzed using Duplex-ultrasound. The symptomatology and CEAP were evaluated.

Results

Great saphenous vein diameters in the intervention group were 0.37 cm initial and 0.32 cm final (p < 0.0001) in the right leg and 0.28 cm and 0.38 cm (p < 0.0001) in the control group. CEAP classification presented worsening in the control group (p < 0.0001). The signs and symptoms in the control vs. intervention group: pain (86.67% vs. 23.33%; p < 0.0001), edema (70.00% vs. 33.33%; p = 0.0045), and leg heaviness (93.33% vs. 13.33%; p < 0.0001).

Conclusions

Compression stockings were effective in controlling the varicose veins related to pregnancy.

Effects of Application of Elastic Compression Stockings on Blood Pressure, Pulse Rate, and Hypotensive Symptoms in Patients with Intradialytic Hypotension

This study was conducted to identify the effect of elastic compression stockings on hypotension in patients with intradialytic hypotension. Subjects of this study were 59 patients (29 in the experimental group, 30 in the control group). Elastic compression stockings were applied to patients in the experimental group during hemodialysis. To evaluate effects of treatment, systolic blood pressure, diastolic blood pressure, pulse rate, and hypotension symptom scores were measured. Results indicated the decrease in systolic blood pressure in the experimental group was less than that in the control group. Hypotension symptom scores were significantly decreased in the experimental group. Considering these results, the application of elastic compression stockings can be regarded as an effective nursing intervention to help prevent intradialytic hypotension in patients undergoing hemodialysis.

Compression Stockings and Pressure Ulcers: Case Series of a Neglected Issue

Pressure ulcers develop in patients who endure long periods of immobilization, often caused by conditions such as musculoskeletal and neurological diseases. Pressure ulcers adversely affect the patient and increase caregiver burden and healthcare costs. Typical sites for these ulcers include the sacrum, trochanters, and heels; they also occur on the nape of the neck, penis, nostrils, helix of the ear, and upper back. Compression stockings are commonly used to prevent and stop the progression of venous disorders, including deep vein thrombosis, but their role in the development of pressure ulcers is not well known. We describe three case reports of pressure ulcer development due to prolonged application of compression stockings. In each case, the nursing staff who were primarily responsible for the prevention of pressure ulcers applied the stockings continuously without any intermittent relief. Moreover, the stockings did not include manufacturer instructions, such as recommended exposure times and applications. We recommend that nursing staff be trained in pressure relief and prevention of pressure ulcers, including rare occurrences, and that manufacturers give detailed guidance regarding the safe use of compression stockings.

Compression in the treatment of chronic venous insufficiency: Efficacy depending on the length of the stocking

BACKGROUND

Below knee two-component compression stockings (AD) have revealed as effective for compression treatment of venous leg ulcers. Upto groin, thigh length stocking (AG) may enhance clinical effects, however wear comfort of these stocking may be affected.

OBJECTIVE

venous haemodynamic in relation to the length of compression stockings.

METHODS

A two-component AD stocking (37 mmHg) and two thigh length stockings (AG 37, with an interface pressure of 37 mmHg; AG 45, with an interface pressure of 45 mmHg) were tested by 16 patients with CVI. Leg volume changes and venous ejection fraction and venous filling index were measured, whilst quality of life and wear comfort were surveyed by questionnaires.

RESULTS

Volume of both the lower limb and the thigh was reduced by AG stockings, whereas AD stockings reduced only the volume of the lower limb and increased thigh volume. Venous hemodynamic, ejection fraction and filling index were improved by AG and AD stockings, AG, however, was superior to AD. Quality of life and comfort of the stockings was assessed as good for AG 37 mmHg, AG 45 mmHg and AD 37 mmHg.

CONCLUSIONS

Thigh length two component stockings (AG) were shown to be superior to below knee stocking (AD) with regard to volume reduction and venous hemodynamic, yet wear comfort was not impaired. These results imply that healing of trophic skin changes e.g. ulcers will be faster when thigh length two component stocking will be worn.

Adherence to and efficacy of different compression methods for treating chronic venous insufficiency in the elderly

Objectives To investigate the adherence to and efficacy of different compression methods in elderly patients. Methods A retrospective review of compression therapy in 120 elderly patients (≥65 years) with chronic venous insufficiency was performed to study the initially preferred compression method, adherence to each method, and its efficacy. Results Initially, an oversize strong stocking (24%), an appropriate size moderate stocking (19%), and bandages (37%) were equally preferred. Adherence at 1 month was 69%, 96%, and 91%, respectively, and they reduced ankle circumferences in C3 patients by 1.8 ± 1.9 cm, 0.3 ± 1.7 cm, and 2.9 ± 1.7 cm, respectively. The improvement rates of C4 symptoms were 79%, 60%, and 91%, respectively. Only three patients (2%) preferred an appropriate size strong stocking. Conclusions In elderly patients, an appropriate size strong stocking was not preferred. The best adherence was achieved by using a moderate stocking, while the best efficacy was achieved by using bandages.

Leg wound infection after coronary artery bypass grafting: A natural experiment comparing use and non-use of a compression stocking

BACKGROUND

Harvest site infections after coronary artery bypass grafting (CABG) are a known complication which represent a serious problem for patients and an increased cost of health care. There is a discrepancy in routine care regarding use of a graduated compression stocking on the leg with the saphenous vein harvest site. Some wards apply a compression stocking postoperatively to all in-hospital patients, others do not. The deep vein thrombosis prevention effect of compression stockings is well documented, but there are no studies of their possible preventive effect on harvest site infections.

AIM

Our purpose was to examine whether the use of a graduated compression stocking for 4-6 weeks after CABG reduced the incidence of surgical wound infection at harvest sites.

METHODS

Data on 377 consecutive CABG patients (September 2011-December 2012) were collected from the hospital's patient registry and Surveillance System for Surgical Site Infections. Logistic regression was used to determine the odds of surgical site infection in patients at two surgical wards adhering to opposite practices regarding the use of compression stocking (stocking group n=296, no-stocking group n=155).

RESULTS

No significant relationship was found between post-operative infection rate and compression stocking routine.

CONCLUSION

In this 'natural experiment' no evidence was found that the use of a graduated compression stocking reduced the incidence of harvest site surgical wound infection. As the treatment of most Norwegian CABG patients involves the use of a graft leg compression stocking, a randomised controlled trial (RCT) is called for to decide which treatment is better.

The clinical effectiveness of two compression stocking treatments on venous leg ulcer recurrence: a randomized controlled trial

Venous leg ulcers affect up to 3% of people aged 65 years and older, present significant pain and suffering, and are associated with long episodes of health care. These chronic wounds recur at rates of up to 69%. A double blind randomized controlled trial was conducted in a home nursing setting in Victoria, Australia to compare the effectiveness of a 23 to 32 mm Hg (moderate) and a 34 to 46 mm Hg (high) compression stocking treatment on venous ulcer recurrence. Participants (n = 100) were monitored for 26 weeks. Study wound recurrence was low (11.8%), and the average time to recurrence was 77.91 days. Adherence to treatment was low (44%) with nonadherence significantly higher in the high-compression stocking group, χ(2)(1) = 8.827, P = .003. Regression modeling found that adherence to treatment significantly predicted study wound recurrence, Wald(1) = 7.917, P = .005. Estimated hazard ratios showed that participants who did not adhere were 9 times more likely to have their wound recur. Risk of recurrence was 3 times greater for those randomized to moderate compression when compared with the high-compression stocking. Implementing strategies that optimize adherence to compression will reduce ulcer recurrence. Once this has been realized, the potential to adhere to high-compression treatment would further reduce the risk of recurrence.

Putting a Class I Stocking over a Class I Stocking Does Not Make a Class II Stocking

OBJECTIVES

To evaluate the interface pressures (IP) obtained by double compression stockings.

METHODS

Ten healthy volunteers with legs fitting size S stockings wore single and double class I stockings, sizes S to 4L. We measured IPs with the patient wearing each stocking standing and supine.

RESULTS

IPs obtained wearing double S size stockings, standing and supine, were 1.7 times and 20 mmHg higher than those obtained by a single S size stocking (52.1 ± 4.7 and 46.4 ± 4.5 mmHg vs. 31.5 ± 3.3 and 27.3 ± 2.3 mmHg, respectively). Despite the decreasing IP with increased stocking sizes, all IPs obtained by double stockings, standing and supine, even with size 4L (43.2 ± 5.1 and 37.3 ± 5.5 mmHg respectively), were significantly higher than those obtained by a single S stocking.

CONCLUSION

Significantly higher IPs were achieved standing and supine, by doubling stockings. We should rather be aware that double stockings in the supine position can result in excessively high IPs.