Nursing care
Compression Stockings: the nurse's role, start to finish
Written and reviewed by Dana Whitfield, RN, MSN · 5 min read · Updated September 2026
Short answer
Compression stockings are measured for correct size before application, put on while the patient is still in bed and before they stand, removed once a shift to inspect the skin, and never rolled down at the top edge. Each step protects against the same risk: a constricting band or an unassessed limb that lets a deep vein thrombosis or a pressure injury go unnoticed.
When it is done and why
Compression stockings, often called TED hose, and sequential compression devices (SCDs) are ordered for patients at risk of venous stasis and deep vein thrombosis: postoperative patients, those on prolonged bed rest, and patients with limited mobility from stroke, fracture, or critical illness. They work by applying graduated external pressure that's highest at the ankle and decreases up the leg, which assists venous return against gravity and reduces blood pooling in the calf.
The order specifies which device, and sometimes both are used together — SCDs for continuous pneumatic compression while the patient is in bed, stockings for graduated pressure that continues even when the SCD is off for ambulation or transport. Neither is a substitute for early mobilisation where that's clinically appropriate. Confirm the order specifies knee-high or thigh-high, and check for contraindications such as active DVT, severe peripheral arterial disease, or significant leg oedema before applying anything, since compression in the wrong clinical picture can worsen the problem it's meant to prevent.
Preparing the patient
Measure the leg before selecting a stocking size. This typically means the calf circumference and the leg length from heel to popliteal crease or to gluteal fold, depending on whether a knee-high or thigh-high stocking is ordered. Sizing charts differ by manufacturer, so use the one supplied with the product rather than assuming a universal fit. A stocking that's too small constricts; one that's too large bunches and loses its graduated pressure profile.
Explain to the patient what the stockings do and why they're staying on, since patients who don't understand the purpose are more likely to remove them or roll them down for comfort. Check the skin on both legs before the first application and note any existing redness, open areas, oedema, or reduced sensation, because this becomes your baseline for every later comparison. Inspect between the toes and over bony prominences specifically, as these are common early sites for skin breakdown under a stocking.
The steps that matter for safety
Apply the stockings while the patient is still lying down, ideally first thing when the legs are least swollen and before the patient gets up to stand or ambulate. Applying them after the patient has been sitting or standing traps existing swelling under the stocking rather than preventing it. Turn the stocking inside out to the heel, ease it over the foot and heel, then smooth it up the leg evenly, working out wrinkles as you go, since a wrinkle or fold creates a localised pressure point.
The single most important rule for daily wear: never roll or fold the top band down, even partway. A rolled-down edge forms a tight constricting band that acts like a tourniquet, which can impair venous return and cause the exact clot risk the stocking was meant to prevent. If a patient rolls it down for comfort, or you find it that way on rounds, reposition it fully and re-teach why it matters. For SCDs, confirm the tubing isn't kinked and the sleeve fits with roughly two fingers' width of slack, then set the device to cycle and check it's inflating on the correct limb.
During the procedure — the nurse's role
Once stockings or SCDs are in place, your role shifts to monitoring rather than repeated application. Check pulses distal to the stocking, capillary refill, and skin colour and temperature at each routine assessment, comparing one leg against the other. A cool, pale, or mottled foot below a stocking is a signal to loosen or remove it and reassess, not to wait for the next scheduled check.
Encourage and assist with ambulation as ordered, since stockings and SCDs support venous return but don't replace the calf-muscle pump activated by walking. When a patient is ambulating, SCDs are typically removed or disconnected for that period and reapplied afterward. Reinforce with the patient and any family present that the stockings aren't to be removed independently for comfort, and that any itching, tightness, or numbness should be reported rather than managed by adjusting the stocking themselves.
After: monitoring and complications
Remove compression stockings at least once a shift to inspect the skin underneath, then reapply. This is not optional even when the stocking looks intact from the outside, because pressure injury and skin breakdown develop under an intact-looking stocking without visible external signs. Look for redness that doesn't blanch, blistering, or breakdown particularly at the heel, over the malleoli, and between the toes.
Watch for signs that compression therapy has failed to prevent its target complication: unilateral calf swelling, warmth, tenderness, or a positive Homans' sign warrant escalation and further assessment for DVT, and the stocking should not be removed or massaged in that case, since manipulation of a suspected clot risks dislodging it. Report any of these findings promptly rather than continuing routine care around them.
Documentation and teaching
Document the measurement taken, the size and type applied, the time of application, and the skin assessment findings at each shift check, including any change from baseline. If SCDs are in use, document cycling confirmation and any periods the device was off for ambulation or procedures.
Teach the patient and family the same three anchors that guide your own practice: the stockings come off once a shift for a skin check, they go back on before standing, and the top edge is never rolled down. Patients discharged home with compression stockings need this teaching reinforced at discharge, along with when to seek care — new leg swelling, pain, or skin changes after they've left the hospital.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our basic care and comfort practice questions are the closest set to what this page covers.
One question from the basic care and comfort set
A nurse is preparing to feed a client who had a stroke and has mild dysphagia. Which action best reduces the risk of aspiration?
Rationale
Upright at 90 degrees with a chin tuck narrows the airway entrance and directs the bolus toward the esophagus — it is the single highest-yield positioning intervention for dysphagia. Thin liquids and straws move fastest and aspirate most easily, side-lying removes the gravity you want, and large bites overwhelm a swallow that is already impaired.
Answer: B
Common questions
How do I know if a compression stocking is the wrong size?
A stocking that leaves deep indentation marks, feels excessively tight, or causes numbness is too small. One that bunches, wrinkles, or slides down is too large. Remeasure and refit rather than continuing with either.
Can compression stockings be worn continuously without removal?
No. They must come off at least once a shift for a skin assessment before being reapplied, since pressure injury can develop underneath without visible outward signs.
What's the difference between TED hose and SCDs?
TED hose are graduated compression stockings that apply constant passive pressure. SCDs are pneumatic sleeves connected to a pump that inflate and deflate in cycles, providing active intermittent compression, often used together with or instead of stockings depending on the order.
Why is rolling the top of the stocking down considered dangerous?
A rolled-down band concentrates pressure into a narrow constricting ring around the leg, which can impair venous return in the same way a tourniquet does. This raises, rather than lowers, the risk of clot formation the stocking is meant to prevent.