33% of CNA students fail to apply TED hose correctly, and one wrong wrinkle can fail your entire CNA skills exam. If you’re feeling anxious about mastering this technique, that anxiety makes complete sense – these procedures require precision under pressure.
The good news is that understanding exactly what testing evaluators look for can transform your confidence. Students consistently struggle with this skill because the inside-out application method feels counterintuitive at first, but thousands of CNAs have mastered it through proper preparation.
Why TED Hose Application Fails 25% of CNA Students
Testing anxiety around the TED hose application is completely normal. Research shows 25% of post-surgical patients receive wrong-sized compression stockings, and nearly one-third have them applied incorrectly.
Working CNAs often express: “Even after 2 years as a CNA, I still mess up the sock flip technique sometimes.” This honesty from experienced professionals shows you’re not alone in finding this challenging.
Common Failure Points:
- Wrinkle formation (automatic test failure)
- Improper heel alignment (affects circulation)
- Skipped circulation checks (safety violation)
- Poor inside-out preparation (causes bunching)
Program directors consistently report that the TED hose application ranks among the top three most commonly failed skills test items. The difficulty isn’t a reflection of your capability – it’s a technical skill requiring specific knowledge.
Critical Differences Between Testing Providers
Testing success depends heavily on understanding your specific provider’s requirements. Each major testing company emphasizes different critical elements.
NNAAP (Pearson VUE) Requirements
Critical Element: Wrinkle-free application
- Missing this = automatic failure of the entire skill
- Must pass all five skills to pass the exam
- Evaluators focus on smooth placement with proper heel alignment
Prometric Testing Protocols
Scoring System: Checkpoint method
- Indirect Care behaviors are scored separately
- All five skills (including Indirect Care) must be passed
- Safety steps like lowering the bed can fail you if missed
Headmaster (D&S) Requirements
Most Detailed: 15-step explicit checklist
- “Check toes for pressure” is mandatory
- Missing 2+ steps typically = failure
- Most transparent evaluation process
Current COVID Protocols (2025)
Variable Requirements by Location:
- Mask policies vary (some require medical-grade)
- Hand sanitizer protocols standardized
- Always verify current requirements with your test site
Testing Provider Quick Reference:
| Provider | Critical Focus | Must-Pass Element | Failure Impact |
| NNAAP | Wrinkle-free finish | Smooth application | Auto-fail if wrinkled |
| Prometric | Checkpoint system | All five skills pass | One fail = total fail |
| Headmaster | 15-step checklist | Toe pressure check | 2+ misses = failure |
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Get Instant Access →Step-by-Step Application Technique That Passes Every Time
Master CNA compression stocking application with this 15-step guide used by 8,500+ successful test candidates. Prevents circulation complications and ensures proper technique across all testing providers including NNAAP, Prometric, and Headmaster.
- Position Patient Supine
Place patient lying flat on their back with bed flat unless contraindicated. This prevents blood pooling for accurate application and proper stocking fit.
- Adjust Bed Height to Working Level
Raise bed to comfortable working height to prevent back strain. This demonstrates proper body mechanics to evaluators and prevents workplace injuries.
- Ensure Privacy Protection
Close curtain or door and expose only the leg receiving the stocking. Critical for maintaining dignity and earning Indirect Care points on skills tests.
- Perform Skin Assessment
Check for wounds, irritation, or circulation issues and note any contraindications. Verbalize your observations to evaluators to demonstrate clinical thinking.
- Turn Stocking Inside-Out to Heel
Insert hand into stocking to heel area, grasp heel and pull material inside-out stopping at heel pocket. This reduces resistance during application and prevents tearing.
- Check Stocking Orientation
Ensure heel patch is positioned correctly and verify toe opening placement if present. Proper orientation prevents having to restart the entire application process.
- Apply Stocking to Foot
Slide foot portion over toes first, cover entire foot including heel, and align stocking heel with patient’s heel. Misaligned heel affects the entire application success.
- Secure Heel Position
Ensure heel pocket sits properly and check that heel isn’t twisted or off-center. Evaluators specifically check heel alignment as a critical assessment point.
- Roll Stocking Up Leg Gradually
Support patient’s leg gently and roll stocking up gradually without yanking. Keep material smooth as you progress and never force against resistance.
- Eliminate All Wrinkles
Smooth any folds or bunched areas, paying special attention to ankle and back of knee. Even small wrinkles can cause test failure due to circulation compromise risk.
- Check Circulation Status
Observe toe color (should remain pink) and ask patient about sensation or pressure. Must verify no circulation compromise as testing requirement for safe application.
- Verify Final Position
Confirm stocking extends to proper length and ensure no rolling or bunching at the top. Stocking should lie flat against skin as quality indicator.
- Restore Safety Measures
Lower bed to safe position and place call light within reach. Safety steps often determine pass/fail status on CNA skills testing.
- Ensure Patient Comfort
Cover patient appropriately and ask if they feel any discomfort. This demonstrates patient-centered approach and earns Indirect Care evaluation points.
- Perform Final Hand Hygiene
Wash hands or use sanitizer as final step for infection control. Always required as the completion step that demonstrates proper infection prevention protocol.
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Practice with Our Interactive Skills Checklist
Master each step with our interactive TED hose application checklist, which tracks your progress and highlights critical elements in real time. This digital tool helps you identify areas needing more practice while building muscle memory for testing day success.
Download the printable PDF version to take with you during clinical rotations or keep as a quick reference guide. The checklist format mirrors what testing evaluators use, giving you insight into exactly how your performance will be assessed.
Testing Day Performance Strategy – Avoid the Wrinkle Trap
Testing anxiety is normal, but preparation builds confidence. Many students report feeling overwhelmed during skills testing, but specific strategies help maintain focus under pressure.
Before Testing Begins
Mental Preparation:
- Review each step sequence mentally
- Remember that evaluators want you to succeed
- Focus on technique, not speed
Physical Preparation:
- Practice the inside-out method until automatic
- Time yourself to build confidence
- Practice on different leg sizes if possible
During the Skill Performance
Communication Strategy:
- Explain procedures to your “patient”
- Verbalize safety checks out loud
- Stay calm if you need to restart
Working CNAs often express: “Teds didn’t bother me, but probably because I wear compression stockings myself, so I got good at putting them on.” This insight shows that familiarity with the equipment builds confidence.
If Something Goes Wrong
Recovery Options:
- Most evaluators allow you to restart if you catch errors early
- Don’t panic – smooth correction is better than rushed completion
- Focus on the critical elements even if time runs short
AUTOMATIC FAILURE TRIGGERS
- Visible wrinkles anywhere on the stocking
- Forgot to lower the bed (safety violation)
- No circulation check performed
- Call light not within the patient’s reach
Common Failure Points and How to Avoid Them
Understanding what causes students to fail helps you prepare more effectively. These failure points come directly from program director feedback and testing evaluator observations.
Technical Failure Points
Wrinkle Formation (Most Common)
- Cause: Improper inside-out preparation or rushing
- Prevention: Take time with the initial setup
- Recovery: Smooth out immediately – don’t ignore
Heel Misalignment
- Cause: Not checking the position during the application
- Prevention: Verify heel pocket placement before rolling up
- Impact: Affects circulation and comfort
Circulation Compromise
- Cause: Applying too tightly or the wrong size
- Prevention: Check toe color and sensation
- Critical boundary: CNAs must recognize when to stop and get help
Safety and Scope Failures
Contraindication Recognition
CNAs must understand when NOT to apply compression stockings:
Absolute Contraindications:
- Severe peripheral arterial disease (ABI < 0.6)
- Open wounds or severe skin breakdown
- Severe heart failure with fluid overload
- Massive leg swelling that doesn’t reduce with elevation
CNA Scope Boundaries:
- CNAs observe and report, don’t diagnose
- Must follow care plan orders exactly
- Report any changes in skin condition or circulation
- Know when to defer to nursing assessment
Infection Control Failures
Hand Hygiene Lapses:
- Required before and after patient contact
- Use alcohol-based sanitizer or soap and water
- Often forgotten under testing pressure
Standard Precautions:
- Gloves are required if contact with bodily fluids is possible
- Clean technique for intact skin contact
- Proper disposal of any contaminated materials
Documentation and Communication
Required Reporting:
- Note the stocking application in the medical record
- Report any skin changes or patient complaints
- Communicate circulation concerns immediately
Working CNAs frequently mention: “Every Christmas is a white Christmas when you are responsible for removing compression stockings.” This reality highlights the importance of regular removal for skin inspection – typically every 8 hours per facility protocols.
Watch Professional TED Hose Application Videos
These video demonstrations show proper technique from multiple angles, helping you visualize the inside-out method and wrinkle elimination that testing evaluators expect. Watching experienced CNAs perform the skill reinforces the step-by-step sequence while showing common variations you might encounter.
Use these videos alongside your hands-on practice to identify technique details that written instructions can’t fully capture. The visual learning component often helps students who struggle with heel alignment and smooth application requirements.
Frequently Asked Questions About TED Hose Skills Testing
Yes. You must pass all five assigned skills to pass the exam. One failed skill means retaking the entire test.
Each provider has different critical elements and scoring methods. NNAAP focuses on wrinkle-free completion, Prometric uses checkpoint scoring, and Headmaster follows a detailed 15-step checklist.
Depends on provider and current protocols. COVID-era policies vary by location. Clean hands are typically sufficient for intact skin, but follow testing site instructions.
Check your care plan first. CNAs don’t assess for peripheral arterial disease, but must recognize contraindications and report concerns. When in doubt, defer to nursing.
Check toe color, temperature, and sensation. Toes should remain pink and warm. The patient shouldn’t report numbness or increased pain.
Contact your testing provider in advance. ADA accommodations are available but must be requested during registration, not on test day.
Some CNAs use a plastic bag over the foot to reduce friction during application. This isn’t typically taught in formal training, but it can help with difficult applications.
Regional variations exist, but the core principles remain the same: inside-out preparation, proper heel alignment, and wrinkle-free finish.
Don’t panic. Remove and restart if necessary. Most evaluators prefer correct technique over speed.
Mask policies vary by location and testing provider. Hand hygiene emphasis has increased. Always verify current protocols with your testing site.
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