PREVENTION & TREATMENT

Venous stasis calls for compression: Which product is right for your patient?

Compression therapy is essential for venous stasis treatment. Use this guide to help choose the right product for your patient.

Elderly person’s legs, one wrapped in compression therapy.

Chronic venous insufficiency (CVI) affects approximately 2.5 million people in the United States.1 Caused by venous walls or valves failing to move blood adequately back to the heart from the legs, CVI causes blood to collect in the lower extremities, leading to a buildup of pressure and swelling. This additional pressure can cause fluid and blood to leak out of veins, which can result in staining and venous ulcers or stasis.

About 20 percent of people with CVI develop venous stasis.1 From poor blood flow and painful swelling to dry, itchy skin and hard-to-heal wounds, venous stasis is a life-long disease that requires ongoing treatment.

Combined with elevation of the leg and ambulation, compression therapy is critical for treating venous stasis.

Compression therapy helps:

  • Return blood flow from the leg back to the heart.
  • Restore normal pressure back in the superficial veins.
  • Prevent and reduce edema by forcing fluid back into the capillaries.
  • Maintain venous wounds.
  • Prevent further venous stasis and deterioration of venous walls.
  • Relieve aching and heavy legs.
  • Increase blood flow to the skin.

“Compression is used to bring the body into homeostasis, the word for body balance,” notes Robyn “Redd” Smith M.Ed., COTA/L, CLWT, CLT, clinical education liaison at SIGVARIS INC. Smith says even physicians may believe that compression is used to squeeze fluid out when, in fact, it is to balance pressure, to “replace the natural function of the body.” Smith draws on the analogy of a leak in a garden hose. “If you put your finger against the hole lightly, it will still leak, but if you push against it with equal and opposite pressure, the leak will stop.” That balancing of pressure forms the basis of compression.

Patient compliance is key

Proper compression therapy starts in a clinical setting, but continues at home, allowing patients to take more control of their symptoms. The challenge is that patients too often give up that control by not complying with their therapy. Even the right compression product will fail if it’s not used, causing symptoms to persist or get worse.

Read more about how to encourage patient compliance:
Patient compliance: Start the conversation
1-2-3: Educational packaging improves patient outcomes
Improve health literacy and achieve better outcomes

There are multiple compression therapy products available on the market. Here, we provide a reference guide to help choose the compression product that’s right for your patient.

Compression garment.

Velcro-adjustable compression garment

Best for: Chronic venous insufficiency (CVI), edema, venous stasis ulcers and lymphedema.

Wear time: The Velcro-adjustable compression garment offers extended wear time of up to seven days, but dressing change frequency will depend on drainage amount.

Patient ease of use: High

Pros:

  • With COMPRECARES Velcro-adjustable compression garments, customized compression is achieved with the ACCUTAB system, allowing for easy adjustment to correct pressure range.
  • High containment, yet comfortable.
  • If used for wound care, allows for checking on wound status without loss of product.
  • Roll-back straps make application easy.
  • Contouring at the calf fits the natural leg shape.
  • Easily worn under normal clothing.
  • Wearer may remove garment to shower or for skin care.
  • Double stitching ensures durability.
  • Fabric is soft and comfortable and designed to wick away moisture to help avoid skin damage.
  • Transition liner provides graduated compression throughout the leg.
  • Liner can be laundered to decrease amount of times garment is washed.
  • Each COMPRECARES pack includes two reusable socks that can be worn for up to six months.

Cons:

  • Contraindicated for acute-untreated cellulitis or other major skin infections, acute-untreated deep vein thrombosis, untreated kidney disease, severe peripheral arterial disease, ankle-brachial pressure index less than 0.5, untreated spectic phlebitis, and acute, decompensated CHF or myocardial infarction.
  • Wearer must have some range of motion.
  • If wearer has foot swelling, a foot garment or larger shoes may be needed.

compression_34flex

ThreeFlex and FourFlex

Best for: Therapeutic compression to manage venous disease and associated edema. ThreeFlex three-layer compression system is intended for lighter compression or for mixed etiology. FourFlex four-layer compression system is intended for the management of chronic venous insufficiency.

Wear time: Up to seven days, but dressing change frequency will depend on drainage amount.

Patient ease of use:
Medium-High

Pros:

  • Inexpensive upfront cost.
  • Multi-layer compression systems such as the FourFlex and ThreeFlex bandage systems may be more durable than two-layer systems.
  • Educational packaging helps with use and patient compliance.
  • FourFlex comes in an extra-large size, which is 25 percent longer than standard size.
  • FourFlex layers include one layer to provide protective cushioning and absorb drainage, a second to provide a conformed wrapping surface and the third and fourth layers for compression and to hold the system in place.

Cons:

  • Can be bulky, making it difficult for a patient to get on footwear.
  • Tends to be overly warm as it traps body sweat.
  • Cannot be self-applied.
  • Must be removed or covered with waterproof covering to shower.
  • Application can be slow.
  • Contraindicated for patients with severe arterial disease.
  • May need two kits for large or odd-shaped legs.

Two rolls of compression dressing.

Two-layer

Best for: Managing venous disease and associated edema.

Wear time: Up to seven days, but dressing change frequency will depend on drainage amount.

Patient ease of use: Medium-High

Pros:

  • The low-profile CoFlex TLC two-layer compression system easily fits under clothing and footwear.
  • Absorbent padding is designed to wick away moisture and control odor.
  • A stocking is included to ease movement.
  • Application is faster than multi-layer systems.
  • Cohesive layer can be torn by hand.
  • Patient information card is included in every kit.
  • An extra-long kit is available for longer legs.
  • A CoFlex TLC Lite version is available for lighter compression needs.

Cons:

  • May not be as durable as a multi-layer system.
  • May not be as conforming as a multi-layer system.
  • Application can be slow.
  • Contraindicated for patients with severe arterial disease.

Legs in full compression stockings.

Compression stocking

Best for: After venous ulcer has healed to prevent reoccurrence.

Wear time:
Compression stockings should be put on in the morning and removed before patient goes to sleep.
Patient ease of use: Medium-Low

Pros:

  • Compression stockings like EMS Thigh-High Anti-Embolism Stockings can be stretched to fit most leg shapes.
  • Feels less medical for patients.
  • Gradient pressure optimizes patient comfort.
  • Made of 80 percent nylon and 20 percent Spandex for effective strength and stretch.
  • Color coding at the toe and top band denote size and length for quick identification.
  • Measuring tape included in each bag as well as in each box for help finding the right fit.

Cons:

  • Requires strength and dexterity for patients to put on.
  • Cannot be worn while sleeping.
  • Tends to slide into skin folds if wearer has large legs.
  • Requires accurate measurement of the legs for effective use.
  • Can be uncomfortable for patients at first, leading to patients opting out of treatment.

Roll of unna boot dressing.

Unna boot

Best for: Helping to heal venous leg ulcers.

Wear time: Up to seven days, but dressing change frequency will depend on drainage amount.

Patient ease of use: Medium-Low

Pros:

  • Inexpensive upfront cost.
  • Disposable, inelastic bandage.
  • Decreases itching and discomfort with impregnated zinc oxide (with or without calamine).
  • May be applied directly over a wound or over a primary dressing.
  • Maintains a moist healing environment.
  • Provides semi-rigid support for conditions requiring mild compression.
  • An inner plastic core makes application easier.
  • Unna-Z Stretch provides elasticity for enhanced conformability and easier application.

Cons:

  • Contraindicated for patients with known sensitivity to zinc and/or calamine.
  • Bandage may slip or ride down due to edema reduction or leg swelling.
  • Single-use item.
  • Extreme discomfort typical in first two hours due to high compression level needed so boot remains in place.
  • Limits ankle movement.
  • Cannot be self-applied.
  • Must be removed or covered with waterproof covering to shower.

Choosing the right compression therapy and patient education are key to managing venous stasis disease, encouraging patient compliance and improving patient quality of life.

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