compression devices. © 2005 - fa davis purposes edema reduction improves healing environment...

Compression DevicesCompression Devices

© 2005 - FA Davis© 2005 - FA Davis

PurposesPurposes

Edema reductionEdema reduction Improves healing Improves healing

environmentenvironment Reduces neuromuscular Reduces neuromuscular

inhibitioninhibition Improves range of motionImproves range of motion Decreases painDecreases pain

Prevention of deep vein Prevention of deep vein thrombosisthrombosis

Increasing venous flow Increasing venous flow prevents clot formationprevents clot formation


Types of UnitsTypes of Units

CircumferentialCircumferential Inflates as a unitInflates as a unit

ConstantConstant Inflates and remains inflatedInflates and remains inflated

IntermittentIntermittent Cycles off and onCycles off and on

SequentialSequential Milks from distal to proximalMilks from distal to proximal Chambers inflate individuallyChambers inflate individually

MediaMedia Air (pneumatic)Air (pneumatic) Chilled water (hydraulic)Chilled water (hydraulic)

Sequential Compression


Physiological EffectsPhysiological Effects

Mechanical pressure Mechanical pressure reduces edemareduces edemaForces venous fluids Forces venous fluids proximallyproximallyDecreases capillary Decreases capillary filtration pressure, limiting filtration pressure, limiting formation of edemaformation of edema

Constant compression Constant compression devices used in the acute devices used in the acute settingsetting

Efficacy relative to simple Efficacy relative to simple elevation has not been elevation has not been substantiatedsubstantiated



Increased lymphatic Increased lymphatic uptakeuptakeLymphatic system Lymphatic system consists of “buds”consists of “buds”Spreads exudateSpreads exudate Comes into contact Comes into contact

with more budswith more buds

Improved absorption Improved absorption and removal of solid and removal of solid wasteswastes

Lymphatic Buds



Range of MotionRange of Motion Reduced fluid from the jointReduced fluid from the joint

Prevents arthrogentic muscle inhibitionPrevents arthrogentic muscle inhibition

Decreased fluid improves joint motionDecreased fluid improves joint motion Decreases hydraulic pressureDecreases hydraulic pressure

PainPain Decreased fluid decreases mechanical painDecreased fluid decreases mechanical pain

Decrease pressure on nerve endingsDecrease pressure on nerve endings Improved vascular function decreases chemical painImproved vascular function decreases chemical pain

Improved blood/oxygen supplyImproved blood/oxygen supply


ContraindicationsContraindications

Possibility of an unhealed fracturePossibility of an unhealed fractureCompartment syndromesCompartment syndromesCurrent peripheral vascular diseaseCurrent peripheral vascular diseaseArteriosclerosisArteriosclerosisEdema secondary to congestive heart failureEdema secondary to congestive heart failureIschemic vascular diseaseIschemic vascular diseaseGangreneGangreneDermatitisDermatitisDeep vein thrombosisDeep vein thrombosisThrombophlebotisThrombophlebotis


PrecautionsPrecautions

The pressure applied should not exceed The pressure applied should not exceed the diastolic blood pressurethe diastolic blood pressure Upper extremity: 40 to 60 mm HgUpper extremity: 40 to 60 mm Hg Lower extremity: 60 to 100 mm HgLower extremity: 60 to 100 mm Hg

Too much pressure may result in ischemiaToo much pressure may result in ischemia

Wrinkling of underlying Stockinette may Wrinkling of underlying Stockinette may result in high-pressure areas.result in high-pressure areas.

Clinical Application of Clinical Application of Intermittent CompressionIntermittent Compression


InstrumentationInstrumentation

PowerPower: Turns the unit on or off.: Turns the unit on or off.TemperatureTemperature: Adjusts the temperature of the fluid. : Adjusts the temperature of the fluid. PressurePressure: Adjusts the amount of compression in : Adjusts the amount of compression in millimeters of mercury (mm Hg) applied to the extremity.millimeters of mercury (mm Hg) applied to the extremity.

This value should not exceed the patient’s diastolic blood This value should not exceed the patient’s diastolic blood pressure.pressure.

On-off timeOn-off time: Controls the proportion of the time that the : Controls the proportion of the time that the compression is on and off. compression is on and off. PumpPump: Turns on the pressure to the appliance.: Turns on the pressure to the appliance.DrainDrain: Removes the pressure and deflates the : Removes the pressure and deflates the appliance.appliance.


Preparation of the TreatmentPreparation of the Treatment

Establish the absence of contraindications.Establish the absence of contraindications.Remove any jewelry on the extremity being treated.Remove any jewelry on the extremity being treated.Determine the patient’s diastolic blood pressure.Determine the patient’s diastolic blood pressure.Note the girth measurement of the body part being treated.Note the girth measurement of the body part being treated.Cover the area to be treated with Stockinette™ or similar material. Cover the area to be treated with Stockinette™ or similar material.

Care must be taken to ensure that this inner layer is free of wrinkles.Care must be taken to ensure that this inner layer is free of wrinkles.Select the appropriate appliance for the extremity being treated.Select the appropriate appliance for the extremity being treated.Insert the injured limb into the appliance. Insert the injured limb into the appliance.

When full-length appliances are used, avoid bunching the garment in When full-length appliances are used, avoid bunching the garment in the axilla or groin.the axilla or groin.

For best results, elevate the limb during treatment. For best results, elevate the limb during treatment. Inflate fluid-filled units before elevating the body part.Inflate fluid-filled units before elevating the body part.

Connect the appliance to the compression unit. Connect the appliance to the compression unit.


Initiation of the TreatmentInitiation of the TreatmentIf applicable, set the TEMPERATURE to be used, generally between 50° If applicable, set the TEMPERATURE to be used, generally between 50° and 55°F.and 55°F.Select the maximal PRESSURE for the treatment. Normal pressure ranges:Select the maximal PRESSURE for the treatment. Normal pressure ranges:

40 to 60 mm Hg for the upper extremity40 to 60 mm Hg for the upper extremity 60 to 100 mm Hg for the lower extremity60 to 100 mm Hg for the lower extremity

Select the ON-OFF times. Select the ON-OFF times. A 3:1 duty cycle (e.g., 45 seconds ON, 15 seconds OFF) is often usedA 3:1 duty cycle (e.g., 45 seconds ON, 15 seconds OFF) is often used Effects of these ratios has not been substantiatedEffects of these ratios has not been substantiated

Select the appropriate TREATMENT TIME. Select the appropriate TREATMENT TIME. Post-traumatic edema: 20 to 30 minutes. Post-traumatic edema: 20 to 30 minutes. Lymphedema: several hours.Lymphedema: several hours.

Inform the individual about the sensations to be expected during the Inform the individual about the sensations to be expected during the treatment. treatment. Instruct the patient to perform gentle range-of-motion (ROM) exercises Instruct the patient to perform gentle range-of-motion (ROM) exercises during the off cycle, if appropriate:during the off cycle, if appropriate:If long-term treatments (i.e., more than 60 consecutive minutes) are being If long-term treatments (i.e., more than 60 consecutive minutes) are being administered, regularly interrupt the session and inspect the extremity being administered, regularly interrupt the session and inspect the extremity being treated for proper capillary refill and sensation or the presence of unusual treated for proper capillary refill and sensation or the presence of unusual marking or unexpected pitting edema.marking or unexpected pitting edema.


Alternate ApplicationsAlternate Applications

Elevate the extremityElevate the extremity Gravity assists in Gravity assists in

venous/lymphatic venous/lymphatic returnreturn

Electrical StimulationElectrical Stimulation Motor-level stimulation Motor-level stimulation

provides muscle pumpprovides muscle pump


Termination of the TreatmentTermination of the Treatment

Reduce the ON time or select the DRAIN mode Reduce the ON time or select the DRAIN mode to remove the air or fluid from the appliance.to remove the air or fluid from the appliance.Allow the appliance to deflateAllow the appliance to deflateGently remove the body part from the appliance.Gently remove the body part from the appliance.Remeasure the circumference of the extremity Remeasure the circumference of the extremity and determine the amount of edema reduction.and determine the amount of edema reduction.Apply a compression wrap and any appropriate Apply a compression wrap and any appropriate supportive devices. supportive devices. Encourage the patient to keep the limb elevated Encourage the patient to keep the limb elevated whenever possible between treatments.whenever possible between treatments.


Typical MaintenanceTypical MaintenanceFOLLOWING EACH TREATMENTFOLLOWING EACH TREATMENT

Check the appliance for tears or leaks. Check the appliance for tears or leaks. If a defect is found:If a defect is found:

Repair the defect with an approved patch kitRepair the defect with an approved patch kit Return the appliance to the manufacturer for repair or discard the appliance.Return the appliance to the manufacturer for repair or discard the appliance.

Clean the appliance using an approved cleanser.Clean the appliance using an approved cleanser.If appliances are machine washable, turn them inside out and close them.If appliances are machine washable, turn them inside out and close them.Some appliances can be sterilized using gas systems.Some appliances can be sterilized using gas systems.

QUARTERLY OR AS INDICATEDQUARTERLY OR AS INDICATEDCheck air/water hoses for defects and replace if necessary.Check air/water hoses for defects and replace if necessary.Clean the external unit using an approved cleanser.Clean the external unit using an approved cleanser.Check the plugs, cables, and cords for knicks, frays, or other visible Check the plugs, cables, and cords for knicks, frays, or other visible damage.damage.

ANNUALLY OR AS REQUIREDANNUALLY OR AS REQUIREDA qualified service technician should perform an inspection and calibration A qualified service technician should perform an inspection and calibration and perform any needed maintenance.and perform any needed maintenance.

compression devices. © 2005 - fa davis purposes edema reduction improves healing environment...

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