Chronic venous insufficiency (CVI) is a condition that can be caused by several different disorders of the leg veins. These leg vein problems might include blood clots (coagulated blood) or varicose veins.
Elderly skin can become dry and itchy, so washing with mild soap and warm water, drying well and applying a moisturizer before bed will help to keep the skin healthy.
Varicose veins are veins that have stretched causing the valves not to work properly. Instead of the vein valves closing after the blood has pumped through, they remain slightly open, which causes some blood to flow back to the feet instead of up to the heart.
These valve issues cause excess blood to pool in the legs, ankles and feet, causing fluid to leak out of the veins, resulting in swelling (edema) and skin changes which, if not treated, can result in fluid leakage from the skin and risk of open wounds developing
There are other reasons for swelling in the legs and feet, including heart and kidney conditions, therefore if the person you are caring for is experiencing symptoms of chronic venous insufficiency, it is important that an assessment by their Physician (MD) or Nurse Practitioner (NP) is arranged to determine the correct diagnosis and treatment plan.
There are several risk factors that may contribute to developing CVI symptoms:
- Varicose veins
- Deep vein thrombosis (DVT)
- Long periods of standing or sitting
- Advanced age
Chronic venus Insufficiency treatment
If the person you are caring for has been diagnosed with CVI, the goal of treatment is to:
- Support the venous system
- Promote good blood flow in the veins
- Reduce any swelling in the legs
CVI treatment includes:
- Elevating the legs – Unless the MD or NP has advised against this due to other conditions, such as poor blood flow to the feet, elevate legs above the level of the heart when sitting or lying down.
- Regular exercise - The calf muscle can be thought of as the heart of the legs. The more calf muscles pump, the better the blood flow back to the heart. If the person you are caring for shuffles, or does not walk using a heel to toe action, their calf muscle may not be functioning efficiently. Leg exercises while seated or lying down, will help the blood to keep moving. Here’s a simple leg exercise that can be done while sitting down:
- Flexing Feet - Bring the toes towards the nose then point them - Flexing the foot upwards and downwards in this way contracts the calf muscle.
- Foot Circles - Circle the foot at the ankle.
- Feet Alphabet - Trace the letters of the alphabet with the toes (only the ankle should be moving and not the lower leg at the knee).
- Avoid crossing the legs
- Losing weight – Speak to the person’s doctor for weight management advice if obesity is a problem.
- Wearing compression stockings – Compression stockings for edema or thrombosis come in various sizes and strengths, from 8-10 mmHg to 40-50 mmHg. Lighter compression stockings (up to 20 mmHg) can be purchased over-the-counter but often stronger stockings are required and a prescription must be obtained after an assessment by an MD, NP, or Nurse.
If the person you are caring for needs compression stockings, it is important that the compression socks have been fitted and purchased or ordered specifically for them, to ensure that they are the right size. For this reason, if more than one person in the home wears compression stockings, clearly label each person’s stockings to avoid mixing them up.
Compression stockings are removed at night and then applied again first thing in the morning before the person gets out of bed. It is important that they are reapplied before, or very soon after getting out of bed, because once the feet are down, when the person is sitting or standing, the swelling will start to come back and the compression stockings may be difficult to put on.
When compression stockings are removed, check the person’s skin for any areas of damage or redness, particularly areas of pressure, such as the heels and ankle bones. Check that the elastics around the top of the compression stockings are not too tight and cutting into the skin.
Elderly skin can become dry and itchy, so washing with mild soap and warm water, drying well and applying a moisturizer before bed will help to keep the skin healthy. Some lotions can damage the fibres and so it is best not to apply lotion directly before applying compression stockings.
How to put on compression stockings
Compression stockings can be tricky to put on especially as they are so snug (which is important to make sure that they are providing the required support). There are several devices to help put on compression stockings so if you are having difficulty, a representative at your local home health care store can show you the available options.
The following technique is an effective way to help someone put on compression stockings:
- Reach into the stocking and grab the toe to turn the stocking inside out just to the heel.
- Slip the person’s toes into the foot section of the stocking and carefully pull the heel section up over their heel. Pull slightly on the toe of the stocking to make sure it is not causing pressure on the tips of the toes.
- Take the rest of the stocking and pull it over the foot and start gradually working it up the leg. Wearing rubber gloves can help with this process. Don’t grab the top of the stocking and pull up – this can rip the stocking.
- Smooth out any wrinkles and check there are no creases digging into the leg, or back of the knee.
- The compression stockings should not be folded at the top, so if they are knee-length stockings and they are extending past the knee, they may be too long and refitting may be required.
- To remove compression stockings, gently pull them down from the top so that they turn inside out.
Caring for compression stockings
The stockings last for around four to six months if they have been hand washed in mild laundry detergent and air-dried. After six months, the stockings are no longer able to provide the strength of compression required, and therefore the person that you are caring for should have a repeat assessment to confirm whether the same strength of stockings are still appropriate.
Compression stockings are for life; they must be worn every day to ensure that the venous systems continues to be supported and reduces the risk of swelling leading to fluid leakage and painful wounds.
When using compression stockings, it is important to inform the person’s MD or NP if any of the following are experienced/observed:
- Pain in the legs, feet or toes that wasn’t there before compression started
- Pins and needles that were not there before compression started
- Any skin damage noted on removal of the compression stockings
- Any increase in discolouration of the toes or feet
You might also like our Elizz article on Anti Embolic Stockings to learn how they’re different from compression stockings, and what conditions they treat.
If you still have questions about chronic venous insufficiency or how to use compression stockings properly, you can get in touch with an Elizz Caregiver Coach online , or call Elizz at 1-855-Ask-Eliz (275-3549).
Elizz is a not-for-profit organization powered by Saint Elizabeth Health Care with a full range of services for caregivers as well as for those in your care. In Canada, Elizz is the place to go for all things caregiving.