Elasticized stockings are specialized hosiery designed to apply precise pressure to the lower limbs. These garments work by exerting graduated compression, meaning the pressure is strongest at the ankle and progressively decreases up the leg toward the knee or thigh. This external pressure helps reduce the diameter of distended veins and improve the function of one-way valves. By supporting the venous system, compression stockings help force blood back toward the heart, preventing pooling in the lower extremities. The main purpose of this therapy is to improve circulation, reduce leg swelling, alleviate aching, and guard against the formation of blood clots, such as deep vein thrombosis (DVT).
Standard Daily Removal Guidelines
For most ambulatory individuals managing chronic conditions like venous insufficiency or edema, the standard protocol calls for daily removal. Wear the garments throughout the day and take them off when preparing for sleep. This nightly removal allows the skin and underlying tissues to rest without the constant pressure exerted by the garment.
The optimal time to apply the stockings is first thing in the morning, before any significant leg swelling occurs. If the legs are already swollen, the garment will be more difficult to put on and may not fit correctly.
When applying the garment, ensure the heel pocket is correctly positioned and the fabric is pulled up smoothly. The entire stocking must lie evenly without any wrinkles or bunching, especially behind the knee or at the ankle. Creases can create tourniquet effects that compromise circulation and injure the skin.
Removal involves peeling the garment down toward the ankle, effectively turning it inside-out. Reapply the stockings in the morning to provide consistent therapeutic benefit when a person is upright and gravity is most likely to cause blood and fluid to pool.
Importance of Skin Assessment and Hygiene
Daily removal of elasticized stockings is necessary to perform a thorough skin assessment and maintain hygiene. While the stockings are off, the wearer or a caregiver should carefully inspect the entire limb for any signs of irritation or injury. Attention should be paid to bony prominences, such as the ankle, heel, and toes, and areas where the stocking band rests.
Skin assessment is a preventative measure against the development of pressure injuries. Look for:
- Unusual redness
- Bruising
- Chafing
- Areas of skin breakdown
Red marks that do not fade within 15 minutes after removal signal that the stocking may be ill-fitting or the pressure is too localized, and this must be reported to a healthcare provider.
The leg should be gently washed and completely dried before the stocking is put back on. Applying a moisturizing cream can help prevent skin dryness and irritation caused by constant contact with the elastic material. Wait until any applied lotions are fully absorbed to ensure the stocking can be reapplied smoothly and to avoid damaging the elastic fibers.
Washing the garments, often every one or two days, is necessary to restore their elasticity and remove skin oils and debris. Following the manufacturer’s instructions helps ensure the stocking retains its intended level of compression for its full lifespan.
Special Considerations for Continuous Wear and Bedridden Patients
There are specific medical situations where a healthcare provider may instruct a patient to wear elasticized stockings continuously, even overnight. This continuous wear is most common in hospital settings for patients who are bedridden or non-ambulatory, often utilizing anti-embolism stockings (sometimes called TED hose) for deep vein thrombosis prophylaxis. In these cases, the risk of a blood clot forming due to complete immobility outweighs the need for nightly removal.
Even when continuous wear is prescribed, the garment should not remain on the limb for days without interruption. Hospital protocols typically mandate brief removal for skin checks, which may occur every 8 to 12 hours, or at least once daily for a thorough inspection and hygiene care. The purpose of this mandatory check is to proactively identify any pressure points or beginning signs of skin breakdown that could lead to a pressure ulcer.
The duration of any deviation from the standard daily removal schedule is determined by the attending physician based on the patient’s specific medical condition and mobility status. For example, a patient recovering from surgery may be instructed to wear the stockings 24 hours a day for a few days or weeks, with brief periods of removal for washing, before transitioning to a daytime-only regimen. Any instruction to wear compression stockings overnight must be explicitly given and monitored by a healthcare professional.