Most clients will need to be shown how to apply compression hosiery. The following points need to be considered:

• When applying stockings, the garment should be turned inside out as far as the heel. Thumbs should then be inserted into the sides of the stocking and the stocking should be slipped on until the heel is in the correct position. The fabric of the stocking should then be gathered up and gently eased up the ankle and the leg. The thumbs should be kept inside the stocking, and the stocking should be spread as evenly as possible until the knee or thigh is reached. If any tight bands and unevenness are present, these should be gently smoothed away.
• The stocking should not be folded over, if it is too high, once it has been applied. This would cause a band of constriction. Instead, the stocking must be removed and reapplied.
• Open-toed stockings are more easily applied if a silky socklet, supplied by the manufacturer, is first slipped over the forefoot and pulled out when the stocking is in position. Similarly, using the lower part of a nylon stocking over the bare leg may help.
• Stockings should be removed at night and put on again immediately on rising, before oedema has collected. The exception to this is when stockings are worn for DVT prophylaxis. These stockings should be worn all the time, both during the day and night and may only be removed for up to thirty minutes to allow time for bathing.
• Some people may feel claustrophobic wearing compression stockings. Therefore, they may need to get used to garments slowly, initially wearing them for one or two hours at a time.
• At the first fittings, any modifications need to be noted. If compression therapy is very effective in reducing oedema, then the leg may need to be re-measured after only a few weeks.
• Aids are available to help apply elastic hosiery. However, these devices rely on the sight, strength and manual dexterity of the client. Applying elastic hosiery may therefore present problems for those with arthritic hips or hands. A relative or friend may need to be relied upon to help.
• If two pairs of stockings are worn at the same time, the pressure is cumulative. Therefore, it is sometimes advisable to recommend that clients wear two pairs of Class 1 stocking as opposed to a Class III stocking. They are easier to apply and equally as effective (Fentem 1986).

Washing elastic hosiery

All articles provide clear washing instructions, which conform to handwashing at 40^oC. It is important that these instructions are followed if hosiery is to maintain its correct compression. Frequent daily washing improves performance by restoring shape and removing damaging skin oils. With good care, stockings should give adequate pressure for three or four months before needing to be replaced.

Elastic hosiery – contraindications

Compression therapy should never be applied in clients with severe arteriosclerosis or any other ischaemic vascular disease. Also, stocking should not be worn if there are any local conditions affecting the leg e.g. skin lesions, gangrenous conditions, or recent vein ligation, as they may compromise the circulation.