Elastic compression garments

​​Elastic compression garments are used to improve symptoms of deep vein thrombosis (DVT) and post-thrombotic syndrome (PTS)​ by helping to transport blood back to the heart. They prevent fluid from pooling in the affected limb, as well as reduce swelling, pain and other symptoms.

What are elastic compression garments?

Elastic compression garments are made of breathable elastic fabrics such as nylon, cotton, spandex or natural rubber. They are occasionally referred to as “graduated compression garments”. The stockings are tightest at the ankle (where the most pressure is put by the body) and become less tight as the garment moves up the leg. A compression sleeve is tightest at the wrist and becomes less tight as it moves up the arm.

Effect of elastic compression garments on damaged veins

Compression garments are typically available in several different lengths and sizes. Stockings can come up to the knee, thigh, or waist, with an option of open or closed toe. Your doctor will prescribe the appropriate garment length, but knee-high stockings are the most commonly prescribed in children with PTS in the legs.

For the arms, sleeves are only made in a full-length style. The sleeve ends about two fingers below the underarm and begins either at the wrist (sleeve-style), the thumb (gauntlet-style) or midway through the fingers (glove-style).

Elastic compression garments gently compress the muscles in the affected limb as well as the expanded vein walls. With the vein walls being less stretched, the vein valves are able to close once again, resulting in healthier overall circulation.

Class of compression

Compression garments are available in various degrees of pressure, or classes of compression. Compression is measured in millimetres of mercury (mmHg), with the highest compression at the ankle or wrist joints. The higher the pressure is, the tighter the garment will fit. There are different compression levels (15-20 mmHg, 20-30 mmHg, 30-40 mmHg and +40 mmHg) depending on what your child needs.

How to wear elastic compression garments

Elastic compression garments are intended to be tight. This can make putting them on difficult, especially when putting them on your child. The following tips will make it easier to put on the garments:

• Wash the garment before the first use, to decrease its stiffness.
• Ensure the limb is dry. It is important to apply moisturizing cream to the skin after each use because garments can cause dry skin. Applying creams at the end of the day, when the garment is removed, ensures that moisturizers are completely absorbed before putting on the garment the following day. This will increase the lifespan of the garment.
• Do not pull the stocking by the top (as with a normal sock), since that will make application more difficult and will take more time. Instead, invert (turn inside out) the stocking halfway and insert the foot until the stocking is over the heel. Next, using your palm rather than fingers, gradually unfold the stocking moving up the leg.
• For sleeves: Invert the sleeve halfway and put the hand through it until the bottom part of the sleeve is at the level of the wrist. Then, use the palm of your hand to glide the sleeve up toward the underarm.
• Technique to remove garments: Holding the top of the garment, peel the sleeve or stocking down the limb. The garment should be inside out once removed.
• After properly applying the knee-high stockings or sleeve, the top of the garment should be approximately one-inch below the bend of the knee or underarm.

An expert garment fitter can show you some tricks and devices to help apply the stocking or sleeve, such as using a donning glove (or a rubber cleaning glove) to make putting on the garment easier.

The length or size of the garment may be wrong for your child if:

• They want to fold or roll the top of the garment down, away from the bend in the knee or underarm.
• The stocking continuously slides or rolls down on its own.

How long to wear compression garments

Although the standard recommendation is to wear the garment from the time your child wakes up, until just before they go to sleep, wearing the garment is especially important when participating in physical activity, travelling, or when your child’s symptoms of PTS worsen.

If swelling is a major concern, it might be best to put the compression garment on when your child wakes up, because the limb will be less swollen then.

Your child does not need to wear their garment at night. Remember that the pressure in the garment, particularly the socks, has been designed for someone that is walking.

Generally, the compression garments are to be worn every day for however long they ease and improve symptoms, which can vary by weeks, months or years.

Expect to return to the thrombosis clinic every year, to check the duration of the treatment.

Washing instructions

Follow the washing instructions on the label of the garments. Wash the garments after each use, if possible. This preserves the fabrics elasticity, and removes oils and dirt.

Do not use detergent! Wash only with mild soap.

Tips for machine-washing

The label of the garment will tell you whether machine washing and drying are permitted. Wash and dry according to the manufacturer’s instructions.

• It is best to use a mesh laundry bag for protection.
• When setting the dryer settings, ensure you’ve chosen the delicate cycle.

Tips for hand washing

• Wet the garment and apply soap.
• Gently rub the fabric together. Try your best not to stretch it.
• Rinse and repeat, if needed.
• Pat the garment dry with a towel. Do not wring and twist it.
• Let it air-dry.

When to replace elastic compression garments

After each use, the fabric of the garment will lose some of its elasticity. Garments generally last about six months. You should contact the thrombosis clinic to get a new prescription before six months have passed, as it may take two to three weeks for the new garment to arrive after ordering.

Where to purchase elastic compression garments

Many medical supply companies and pharmacies sell elastic compression garments. Ask your health-care provider which company they recommend. It is best to talk to an expert garment fitter to check options and learn how to properly apply and remove the garments.

The garment fitter will take your child’s arm or leg measurements, to make sure they get a sock or sleeve that fits properly. Every brand uses different methods of measurement, the most common being measuring the diameter along the patient’s leg or arm at various locations.

There are many ready-made socks or sleeves you can buy, which come in various sizes. Garments can also be custom made for your child. For small children, a custom sleeve or sock is usually necessary.

Socks are usually sold in pairs, but it is only necessary to wear the garment on the affected limb.

Insurance coverage

The cost of elastic compression garments depends on the compression level, brand, style and place of purchase. Customized fittings tend to be more expensive.

Some insurance companies do cover compression garments. It is best to consult your insurance benefits. Some companies require a letter from the doctor mentioning they prescribed the garment. Ask the thrombosis doctor who prescribed your child’s garment to provide you with a letter.

When to see a doctor

Stop using the compression garments and contact the thrombosis clinic or the thrombosis doctor in case of:

• increase in pain with the use of compression garments
• change in the color and temperature of the skin with the use of compression garments: toes turn pale and cold or purple.
  

For more information on thrombosis, post-thrombotic syndrome and the management of these conditions, please visit the Thrombosis Learning Hub.