Compression stockings, often referred to as TED hose or anti-embolism stockings, are specialized garments designed to apply graduated pressure to the lower leg. This compression is greatest at the ankle and gradually lessens higher up the leg, improving blood flow back toward the heart. After major surgery like knee surgery, limited movement reduces the body’s normal circulatory mechanisms. Correctly applying these stockings is precise, especially with reduced mobility and pain.
Why Compression Garments are Necessary After Surgery
Reduced mobility following major joint replacement surgery significantly elevates the risk of developing deep vein thrombosis (DVT). DVT occurs when a blood clot forms in the deep veins, typically in the calf or thigh, due to stagnant blood flow. Compression garments counteract this pooling effect, known as venous stasis, by gently squeezing the veins and encouraging a faster return of blood.
The graduated pressure profile ensures the veins are compressed most effectively where blood pooling is likely to occur. This mechanical support improves the velocity of blood flow, reducing the likelihood of clot formation. Furthermore, the sustained pressure assists in managing post-operative swelling, or edema, in the lower leg and foot. Controlling edema is important because excessive swelling can cause discomfort and hinder early physical rehabilitation.
Preparing the Leg and Utilizing Application Aids
Before attempting to put on the stocking, the leg must be completely clean and dry. Moisture significantly increases friction, making the garment nearly impossible to slide into place. Applying a small amount of cornstarch or specialized donning powder creates a smoother surface and reduces fabric drag. This step prevents excessive pulling on the leg and minimizes strain on the new knee joint.
Mechanical donning aids, such as sock assist devices or frames, are strongly recommended to help patients avoid bending at the waist and flexing the operated knee. These tools typically involve a trough onto which the stocking is loaded, allowing the patient to pull the garment onto the foot using long straps. Additionally, using rubber gloves provides a better grip on the slick, tight material. The improved traction helps distribute the pulling force evenly and protects the fabric from being snagged.
Step-by-Step Guide to Proper Application
Begin the application process by sitting in a stable chair with arms, or on the edge of the bed, ensuring the back is supported and the operated leg is positioned in front. The first step involves reaching into the stocking and pulling the material inside out, down to the heel pocket. This technique concentrates the tightest part of the garment at the foot, which is the most challenging area to manage.
Gently slide the foot into the stocking, guiding the toes until the heel is properly seated in the heel pocket. Ensure the foot is fully inside before attempting to pull the material further up the leg. Once the heel is correctly placed, gather the remaining folded material and use your fingers or rubber-gloved hands to slowly roll or walk the stocking up the calf.
The key to minimizing stress on the knee is to advance the stocking only a few inches at a time, using short, controlled movements. Avoid any forceful tugging, as this gradual application prevents the material from bunching up. Continue working the stocking up the leg until the top band sits comfortably just below the operated knee or at the prescribed thigh level, without folding the top edge over. Immediately smooth out all wrinkles or creases, which can create pressure points.
Monitoring Skin Health and Safety Precautions
Once the compression stocking is worn, regular monitoring of the skin and circulation is necessary to ensure safety and comfort. Stockings should be removed at least once daily—usually before bedtime or during a shower—to allow for a thorough skin check. Look for any signs of irritation, excessive redness, or indentations caused by the garment, particularly behind the knee or around the ankle.
Patients must also check the foot and toes of the operated leg for signs of impaired circulation, such as coldness, numbness, or discoloration. If the stocking causes excessive pain, or if it rolls down and creates a tight, constricting band, it must be readjusted immediately or removed. Any severe or persistent symptoms, including increased pain or sudden numbness, should be reported to the surgeon or healthcare provider right away.