Side effects

Side effects of loop and potassium sparing diuretics are uncommon when taken at the recommended doses. Many patients must empty their bladder more frequently for several hours after taking their diuretic. Although some symptoms may result from the loss of sodium and potassium, most patients tolerate diuretics very well.

Body positioning

Leg, ankle, and foot edema can be improved by elevating the legs above heart level for 30 minutes three or four times per day. Leg elevation alone may be sufficient therapy for patients with mild venous insufficiency, but is usually not adequate for more severe cases. In addition, it may not be practical for those who work to elevate their legs several times per day.

Compression stockings

Leg edema can also be prevented and treated with the use of compression stockings. Many types are available, including knee-high, thigh-high, and pantyhose. Knee-high stockings are sufficient for most patients; thigh-high stockings are less desirable because they tend to provide too much pressure behind the knees, reducing blood flow in the veins and causing discomfort.

Compression stockings that have varying degrees of pressure are best; the greatest pressure is applied at the ankle. The pressure should gradually decrease up to the knee. The white "antiembolism" stockings commonly given to patients in the hospital do not apply enough pressure at the ankle and are not adequate treatment for venous insufficiency.

Proper measurement and fitting of the stockings are important for the patient's comfort and safety. The following tips may also be helpful:

• Washing new compression stockings before wearing will reduce some of the initial stiffness and difficulty in putting them on.

• The stockings should be put on as early as possible in the morning when edema is minimal.

• Patients should lean against a firm back support (not on the bed) while putting on the stockings.

• Knee-high stockings can be put on by turning the leg portion of the stocking inside-out down to the heel. With the stocking stretched, the foot is slipped in while pulling the stocking firmly onto the foot by its folded edge. As the stocking is pulled on by the edge, it will turn right-side out and can be gently worked up the leg. Some manufacturers recommend wearing rubber gloves to slide the stocking up the leg rather than grasping and pulling the edge of the stocking.

• Heavy compression stockings may go on more easily if a light silk hose is worn under the compression garment, or if talcum powder is first applied to the foot and leg. Some patients do not have the strength or mobility to pull on compression stockings. Stockings are now available with a zippered back or velcro attachment.

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EditText of this page (last edited December 19, 2009)