As with any remedy to alleviate or eliminate a discomfort that is bothersome, caution and education are the first and most important steps before the use of compression stockings.
This includes an appointment with your primary physician for a thorough assessment of whether or not you are a candidate for compression garments.
There are situations and conditions that may prevent individuals from using compression legwear or other types of compression wear. The medical term for this is called contraindication.
This is a situation or a symptom where it is not advisable to use a drug, procedure, surgery or in the case of compression therapy, compression stockings, garments or devices, because it may be harmful to the individual or patient using it.
These so-called contraindications can be broken down further into what is known as absolute and relative contraindications.
Examples for Situations of Absolute Contraindications with Compression Stockings
This is the case with conditions where individuals should absolutely not use compression stockings because the risk of causing harm would be far greater than the potential benefits.
Advanced peripheral occlusive arterial disease – Indications can be patchy skin discoloration and/or dead skin cells or skin tissue also known as necrosis. An evaluation by an angiology specialist may be necessary. An angiologist studies the diseases of the circulatory and lymphatic system, such as arteries, veins and lymphatic vases.
Acute decompensated heart failure (ADHF) – Is defined as the sudden start or worsening of the symptoms of heart failure often caused by cardiogenic pulmonary edema. ADHF can lead to severe and potentially fatal breathing distress.
Plegmasia coerulea dolens – This is an uncommon, severe form of deep vein thrombosis (blood clots in the vein), usually in the upper leg. This condition can lead to increased swelling and interference with blood flow. It causes the skin to turn white and in severe cases can lead to tissue death (gangrene) resulting in amputation of the affected limb. If an arm or leg is severely swollen or painful, seek immediate medical attention.
Septic phlebitis – Inflammation of a vein due to an infection. Septic phlebitis frequently occurs with long-term use of an intravenous cannula. Septic phlebitis is difficult to distinguish from thrombophlebitis or venous thrombosis, which requires short-term or long-term compression treatment depending on the doctor’s recommendations.
Examples for Situations of Relative Contraindications with Compression Stockings
These are cases with conditions where the benefits of using of compression stockings may outweigh the risks. Close and regular monitoring by medical or nursing staff will be necessary for the duration of the compression treatment.
Gangrenous conditions including peripheral vascular disease (PVD) – Is the most common disease of the arteries. The name is often used as a synonym for peripheral artery disease (PAD). Another name is arteriosclerosis, or hardening of the arteries, caused by fatty deposits in the blood vessels. This illness causes decreased, or in severe cases, complete blockage of blood flow. If it cannot be corrected it can lead to serious infections, death of tissue and amputation of affected limbs.
ABPI (ankle brachial pressure index) less than 0.8 or falsely elevated e.g. due to diabetes – A low ankle-brachial index number can be an indicator for narrowing or blockage of the arteries in the legs, which can lead to circulatory problems, heart disease or stroke. With diabetes, a patient can show a falsely elevated ABPI caused by calcification of the arterial wall. A study in 2008 found plaque in the arteries of 62% of the participants with a falsely elevated ankle brachial pressure index.
Patients with absent foot pulses – Absent foot pulses can be a strong indication of whether a patient has peripheral vascular disease.
History of intermittent claudication – Is a condition of the leg caused by blockage of the arteries. This condition causes pain in the legs when the person is walking, which can be relieved by rest. A patient with intermittent claudication may have muscle pain, aching, cramps, numbness or a sense of fatigue. During examination there may be weak or non-existent pulses in the lower limb and the leg may appear blue and feel cold to the touch.
Femeropopliteal bypass grafts – This procedure is used to restore a blood flow pathway to the leg that has a blocked artery. The graft can be a healthy blood vessel from one’s leg or arm or it may be man-made. This may not only improve the blood flow to the leg and foot but it can also reduce the risk of ulcers from poor circulation.
Peripheral neuropathy – Peripheral neuropathy (PN) is a condition where the nerves are not functioning properly either because they are damaged or destroyed. Peripheral neuropathy can have many reasons. For example it can be caused by diabetes, following trauma, from toxins or due to alcoholism just to name a few possible reasons. It can also occur for no obvious reason at all.
Pulmonary edema – Is a condition where water like fluid accumulates in the lungs. According to the Mayo Clinic in most cases it is caused by heart related problems. Some other causes can be pneumonia, medications or living in higher elevations.
Lymphedema – Lymphedema is an abnormal buildup of fluid that results in swelling. It is most often seen in the arms or legs. The condition occurs when lymph vessels or lymph nodes are compromised, missing, damaged or have been removed.
Severe sensory disorders (paresthesia) of the extremities – Such conditions are characterized by the complete loss or diminished sensations in the extremities frequently resulting in complaints of numbness and tingling in the affected areas. The evaluation of sensory disorders can be rather frustrating and difficult, especially due to the subjective nature of the symptoms and the wide range of reasons that can cause it.
Advanced peripheral neuropathy (e.g. in cases of diabetes mellitus) – Peripheral neuropathy (PN) can have a multitude of causes. Most cases show muscle weakness and sensory loss, positive sensory symptoms and sometimes pain. One of the most common painful neuropathies is diabetic neuropathy.
Pronounced exuding dermatoses – Skin diseases with ulcers or open wounds that are leaking pus and fluid.
Intolerance to the material of compression stockings – If the patient develops a rash this could suggest an allergic reaction to the material of the compression stockings.
Rheumatoid polyarthritis – Arthritis affecting five or more joints. Polyarthritis is often caused by autoimmune conditions such as rheumatoid arthritis.
IMPORTANT: The indication for applying a compression bandage or stocking must be determined by a physician or specialist since he also takes responsibility for monitoring the contraindication.
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