Use of compression hosiery in venous andlymphatic conditionsCompression hosiery plays an important part in the management of chronic oedema and in theprevention and treatment of varicose veins byhelping to reduce oedema in the lower limbs.

The compression hosiery category has gone through a number ofchanges and developments recently. The introduction of new fabrics,knitting technologies and styles on the NHS provides customers with agreater choice of attractive, lightweight and easy-to-apply garments indifferent styles and colours which offer a solution in helping to manageany venous or lymphatic condition.

The introduction of these effective and cosmetically appealing garmentsmeans that many customers with chronic oedema, varicose veins or venousulceration can now be treated and monitored within the community,instead of being hospitalised. As customers often have to wearcompression hosiery for life, the pharmacist plays an important role in thecare of the condition, ensuring that every customer has the appropriategarment to prevent any recurrence or deterioration of the condition andmore importantly, helping them to lead a normal and active life.

Pharmacists and their staff are ideally positioned to help by:

• Looking out for customers who are not collecting their hosieryprescriptions

• Asking customers who are collecting repeat hosiery prescriptions if theyare content with their garment and if it is helping their condition

• Being aware of any complaints of hosiery not fitting properly anddigging in, which is causing discomfort

• Being aware of customers having difficulty putting on their hosiery

• Encouraging customers to have regular measuring sessions every sixmonths to check that their hosiery size is still correct.

You should also look out for customers who are suffering from untreatedswelling of the limbs, leg ulcers, bulging veins, or even changes in theappearance of the skin on their lower limbs. Explain to these people theuse and purpose of compression hosiery in helping with these conditionsand that they should seek advice from their GP.

Aims of this trainingThis CPD Guide, brought to you by Activa Healthcare, is designed to improve your knowledge of compression hosiery and venous and lymphatic conditions, and act as a CPD trigger. Specifically, this module will:

Provide you with up-to-date knowledge on the different ranges of compression hosieryExplain the role of these products in maintaining healthy limbsHelp you to ensure customers use the best and appropriate garment for their condition.

Improving customer care in compression hosiery

Reflective questions

Think about the following areas:What is my understanding of the conditions that benefit fromcompression hosiery?

Which ranges of compression hosiery are available onprescription?

What role can pharmacy play in helping customers managevenous and lymphatic conditions?

A C P D G u i d e T o V e n o u s L e g H e a l t h

Benefit of compressionhosiery

Customer benefitsCondition

Improves venous return ofblood by:

• Supporting weakenedvalves and vein walls,preventing backflow

• Improving upwardmovement of blood.

• Eases symptoms such aspain, throbbing, swelling

• Reduces swelling

• Improves the appearanceof unsightly, bulging veins

• Reduces complicationssuch as eczema, phlebitis.

Varicoseveins

• Reduces risk of DVTdeveloping

• Exerts graduated pressureon the leg

• Helps venous system byreducing venous stasis,which can lead to clotting

• Increases blood flow andvolume, preventingthrombosis.

Customers should wearcompression hosiery fromthe start to the end of theday.

Deep veinthrombosis (DVT)

• Enhances venous return byputting increased pressureon the superficial and deepveins of the limbs

• Higher pressure placed at theankle and less pressure atthe knee encourages bloodflow towards the heart

• Reduces reflux and preventsoedema at the ankles.

• Helps to manage andcontrol swelling

• Reduces risk ofcomplications such asskin changes

• Minimises complicationssuch as cellulitis

• Improves mobility

• Eases discomfort and pain.

Chronicoedema (swelling in legspresentfor morethan threemonths)

Leg ulcer kit provides effectivetreatment by:• Encouraging healthy flow of

blood back to the heartcreating correct environmentfor healing

• Compression hosiery can beused to prevent recurrence.

• Reduces risk of furtherinfections

• Improves appearance ofthe leg

• Cosmetically appealingand more comfortablethan a bandage.

Venouslegulcers

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Selecting hosiery to meet customer needsPharmacists and their staff play a vital role in helping customers to use compression hosiery in the treatment and/or prevention ofmany venous and lymphatic conditions. The following examples are intended to demonstrate ways to help customers, and providean overview of the types of hosiery that are available.

As you are handing out a prescription for a pair of Class 2 hosiery, the customer tells

you that she is very reluctant to wear the hosiery as she finds them uncomfortable to wear and difficult to put on.

On checking, you discover she has not been measuredfor over 12 months. Therefore her legs need to be re-measured so she can have hosiery that fitscomfortably as well as help manage her condition.

A customer has lymphoedema associatedwith varicose veins. When handing in a

prescription for thigh length stockings BS Class 2 thighlength, she says she doesn’t want a repeat prescription ofthe hosiery. On enquiring further, she tells you that she isballooning out of her hosiery so she feels veryuncomfortable as they are digging into her thighs. She isalso having great difficulty putting them on. On checkingher PMR, it shows that she has not been measured for atleast 12 months. It is apparent that BS Class 2 hosiery isnot controlling the oedema in her lower leg.

Customer 1 Customer 2

Solution

After measuring this customer,you could recommend she triesthe new Activa Unisex PatternedSocks, which are stylish but stilloffer the maximum compressionto help with her condition. Thesmooth and silky texture of thesocks make them easy to put on.

Solution

This customer needs to bemeasured again to ensure thecorrect size of hosiery isrecommended. Then, contactthe GP to explain the problemand suggest she tries ActiLymphEuropean Hosiery Class 2 thigh length.

Activa BS Hosiery

An effective range of compression hosiery to treat avariety of mild venous symptoms and early skin changeswhen there is no oedema.

Customer benefits:Available in thigh or below the knee styles

Cosmetically appealing

Comfortable, soft and silky to the touch

Easy to apply

Large heel sack and no restriction at the toes

Supports and encourages venous return

Wide range of styles and colours to match thedifferent needs of customers.

ActiLymph European Hosiery

Chronic oedema is associated with the first signs of lymphaticfailure and is a precursor to lymphoedema. ActiLymph hosierywas developed to treat and manage chronic oedema andlymphoedema after bandaging has reduced the swelling. Canalso be used if leg ulcers are not responding to BS garment orif swelling is presenting.

Customer benefits:Helps increase venous and lymphatic return, aidingabsorption of excess limb fluid

Manages chronic oedema

Specialist knit creates a stiffer garment that provides theideal solution to fight and contain lower limb oedema byproviding a more rigid cuff around the limb (similar to aninelastic bandage function)

Elasticated heel and toe sack, offering compression and support

Improves tissue condition

Wider welt – helps the garment to stay in place.

For further information on the extensive range ofActiva hosiery, please visit: www.activahealthcare.co.uk

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A customer who has a long history ofrecurring leg ulcers presents a prescription

for Activa Leg Ulcer Hosiery Kit. She wants to knowwhat this is and hopes it is not those ‘thick Nora Batty stockings’.

Customer 3

“Provides customers witha greater choice of

attractive, lightweightand easy-to-apply

garments in differentstyles and colours.”

Solution

Explain that she will bewearing two garments – a silkyliner that is easy to apply, thena stocking that will glide overthe liner. These two garmentstogether will give thecompression required forhealing but without bulkycompression bandages. Thismeans she will be able to wear her normal shoesinstead of oversized slippers and the hosiery willmake her leg look normal, so people will not knowshe has a leg ulcer.

Activa Leg Ulcer Hosiery KitAn effective and comfortable alternative to bulky compressionbandages.

Customer benefits:Provides higher levels of compression that can be appliedby the customer

Saves nurses’ time, as the customer can self-apply thegarments

Encourages the use of the calf pump

Allows normal footwear to be worn as bulky bandagesusually mean the wearing of oversized slippers which causethe wearer to ‘shuffle’ as they walk.

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Customer careChoosing an Activa garmentAfter measuring a customer for compression hosiery, use the Activaonline Hosiery Selector to choose the ideal product. It can be found at:www.activahealthcare.co.uk

How to apply compression hosiery Tips for customers on applying theirhosiery:

Try putting the hosiery on first thing in

the morning before getting out of bed

Wear rubber gloves to help grip the

hosiery

Suggest using the unique hosiery

applicator from Activa – Actiglide. It is

available on NHS prescription. Improvingcustomer care in lower limbchronic oedema

Forthcoming module

No part of this publication may be reproduced without the written permission of the publishers, Activa Healthcare in association with CIG Healthcare Partnership. © CIG Healthcare Partnership, Linen Hall, 162-168 Regent Street, London W1B 5TB. www.cighealthcare.co.uk

Caring for compression hosieryAll customers should be told thatthe hosiery is guaranteed for 100washes or for three months. Thegarments should be hand ormachine-washed at a maximumtemperature of 40°C and nottumbled dried. Also advisecustomers to regularly check theirfeet for hard skin or calluses orsnagged nails that might damagethe hosiery.

Caring for legsAdopting a good skincare routine willhelp customers maintain the conditionof their skin and prevent furthercomplications such as ulcers.Customers should be advised to:

• Moisturise legs regularly

• Walk and exercise regularly

• Check their legs and feet regularly for anyskin changes or sores

• Seek treatment for any knocks or sores.

This module can be used as a CPDopportunity. The following questions will helpyou get the most out of this module.

ReflectRevisit the questions from the beginning ofthe module.

PlanDo I need to improve my knowledge of theuse of compression hosiery?

Which customers should I be targeting to giveadvice to on the use of compression hosiery

ActWhat role can my staff play in helpingcustomers get the best from theircompression hosiery, and in helping to detect customers who are not receiving thistreatment.

EvaluateDo I have any further learning needs on this topic?

CPD for pharmacists &pharmacy technicians

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