8.4 Prosthetic, Orthotic & Elastic Stocking Care
Key Takeaways
Use each resident's own prescribed prosthesis, orthosis, or stocking and follow the wearing and skin-check schedule.
Do not force a device, adjust its clinical settings, or add improvised padding to compensate for poor fit.
Observe pressure areas and report pain, persistent discoloration, swelling, numbness, or open skin promptly.
Elastic stockings require correct size, smooth material, and nurse-established circulation precautions; do not roll the top into a tight band.
Distinguish Replacement from Support
A prosthesis replaces a missing body part or structure, such as an artificial limb, breast prosthesis, or denture. An orthosis supports, protects, or positions an existing body part, such as an ankle-foot orthosis, hand splint, or spinal brace. South Dakota's CNA curriculum requires using and caring for these devices. Their purpose is functional independence and protection, but poor fit or incorrect use can create pressure injury, pain, falls, or loss of function.
The CNA does not select a prosthetic socket, change brace angles, prescribe compression, or decide that a resident no longer needs a device. Follow the care plan, therapist/prosthetist instructions, and manufacturer's cleaning directions. Check that the device belongs to the correct resident and that required training has been completed. Ask for a demonstration rather than improvising a fastening sequence.
Before Applying a Device
Explain what you will do and ask about comfort and the resident's usual technique. Encourage safe independent participation. Check the wearing schedule, whether the device is needed for a transfer, skin precautions, and what to do if fit is poor. Gather the required socks, liner, straps, or footwear and inspect for damage or dirt.
Look at the skin contact areas as assigned. Report new pain, redness or other persistent color change, blisters, open areas, swelling, unusual warmth, numbness, or a change in limb size. Skin injury may develop without pain in someone with reduced sensation. Do not cover an open area with improvised padding and force the device back on. Obtain nurse direction before proceeding when a new problem is present.
Artificial Limb Support
A prosthetic limb may have a liner, socket, suspension system, joints, and a foot or terminal device. These components are fitted individually. Assist with application only by the trained method and maintain prescribed alignment. Do not insert extra material, change the sock-ply arrangement independently, tighten hardware, lubricate components without instructions, or use a damaged locking mechanism.
The residual limb is the remaining part after amputation. Provide the assigned gentle skin care and make sure the skin and liner are appropriately dry before application. Clean and dry reusable components according to their directions, and store them where they will not be damaged or mistaken for another resident's equipment. Report changes in fit after weight change or swelling; discomfort is not a reason to tell the resident to "walk it off."
Before ambulation, verify the transfer plan, assistive aid, footwear, and required help. A familiar device does not guarantee the resident can bear weight safely today. If it loosens or the resident develops pain, stop movement using the trained assistance method and call for help. Never detach a supporting device while the resident is standing.
Orthoses, Splints, and Positioning Devices
A splint or ankle-foot orthosis can support a functional position or protect a joint. Application direction, fastening tension, liner placement, and wearing intervals are device-specific. Place the heel or limb correctly, smooth the liner, and fasten only as trained. A strap should secure the device without causing pressure, constriction, or skin trapping.
| Device concern | Appropriate CNA response |
|---|---|
| Persistent pressure mark after removal | Report and follow nurse direction before continued wear |
| Loose or broken fastener | Keep unsafe equipment out of use and obtain the approved replacement/repair process |
| Resident refuses the device | Respect refusal, check discomfort, report, and document accurately |
| New numbness, coldness, or color change | Obtain prompt clinical assessment; do not wait for routine rounds |
A positioning roll, hand support, or boot is not automatically appropriate for every immobile resident. Some devices can increase pressure or restrict movement. Use them only as directed and check the skin, limb position, and resident response. Do not force a contracted hand open around a roll or strap a limb into a position beyond its permitted range.
Elastic and Anti-Embolism Stockings
Elastic stockings may be prescribed to support circulation or reduce venous clot risk. Anti-embolism stockings and other compression products are not interchangeable simply because they look similar. The nurse determines suitability, measurements, size, type, and wear/removal schedule. Arterial disease, skin problems, altered sensation, or swelling can change safety and require reassessment.
Before application, verify the correct resident, product, and size. Follow instructions for turning the stocking to the heel pocket or using a donning aid, then ease it over the foot and up the leg without pulling against fragile skin. Position the heel correctly and smooth wrinkles and folds. Do not roll the top down, twist the stocking, cut it, or layer another product over it to create more pressure. Smooth material should not become a tight band.
Remove and reapply only according to the assigned schedule and technique. At removal, provide authorized hygiene and inspect skin, especially heels, toes, and edges. Report persistent marks, pain, swelling, or circulation changes immediately. Do not massage a painful swollen calf. Sudden breathlessness or chest pain requires emergency escalation. Document actual wear, refusal, skin findings, and nurse notifications.
Sensory and Other Personal Prostheses
Dentures, hearing aids, eyeglasses, breast forms, and other personal devices may be essential for identity, nutrition, communication, and participation. Ask the resident how they prefer assistance and follow instructions for cleaning and storage. Do not put removable items into napkins, unmarked cups, or shared drawers. Never remove or clean an artificial eye without specific training and direction.
After care, confirm the resident is comfortable and can use the call device, clean the equipment appropriately, and store it in a labeled safe place. Record changes in tolerance or function. A useful report describes the exact problem: "Brace edge leaves persistent dark mark on outer ankle; resident reports burning; application stopped and nurse notified." The report supports reassessment without the aide diagnosing a device-related injury or altering the prescription.
Device-care references: NHS anti-embolism stocking care; MedlinePlus artificial limbs. These clinical references support care principles; South Dakota rules and the resident's plan govern the assignment.
Sources checked October 16, 2026
IDDSI food and drink framework; Pressure injury prevention; NPIAP staging.
A resident's ankle brace now causes burning and a persistent pressure mark. What should the CNA do?
Add folded gauze and tighten the straps
Stop application, protect the skin, and promptly notify the nurse for reassessment
Tell the resident discomfort is expected and continue the walk
Cut the brace edge to remove pressure
Which action is correct when applying prescribed elastic stockings?
Roll the top into a tight band so it stays up
Use any resident's spare stocking if the color matches
Apply two sizes smaller when edema increases
Verify the ordered size/type, position the heel, smooth wrinkles, and follow the skin-check schedule
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