Compression

Question 1

What is the standard compression pressure recommended at the ankle?

Answer 1

30–40 mmHg at the ankle is the standard pressure.

Question 2

What compression pressure is recommended for patients with severe venous insufficiency?

Answer 2

40–50 mmHg can be used for severe venous insufficiency.

Question 3

What compression pressure is recommended for patients with mild arterial insufficiency?

Answer 3

20–30 mmHg is recommended for mild arterial insufficiency.

Question 4

What are the three primary effects of compression on the venous system?

Answer 4

• counteracts gravity
• removes fluid from tissues
• improves venous return

Question 5

What are the dynamic effects of compression during movement?

Answer 5

Dynamic effects include changes in leg circumference, when walking, that promote fluid movement out of the limb.

Question 6

How does external pressure improve microcirculation?

Answer 6

External pressure increases limb pressure, enhancing the force needed to push fluid out and improving microcirculation.

Question 7

What are the primary indications for using compression therapy?

Answer 7

Compression therapy is indicated for peripheral edema, scar management, and promotion of venous return.

Question 8

What is the ABI threshold below which compression is contraindicated?

Answer 8

Compression is contraindicated if the ABI is < 0.7.

Question 9

What conditions require caution or are contraindications for compression bandaging?

Answer 9

Conditions include:

• uncompensated CHF
• severe PAD
• untreated DVT
• active infection
• septic phlebitis

Question 10

Why is compression therapy initiated slowly in patients with CHF?

Answer 10

Compression is initiated slowly to ensure tolerance and avoid overloading the compromised cardiovascular system.

Question 11

What is a contraindication for compression if absolute ankle pressure is considered?

Answer 11

Compression is contraindicated if absolute ankle pressure is less than 60 mmHg.

Question 12

What are the general guidelines for tension in compression bandaging?

Answer 12

• Tension is inversely related to bandage width and leg circumference
• Narrow bandages and smaller limbs result in higher compression

Question 13

What is the primary force created by the elastic recoil of a compression product?

Answer 13

Pressure is the primary force created by the elastic recoil.

Question 14

What does higher stiffness in a compression product indicate?

Answer 14

Higher stiffness indicates greater physiological impact and resistance to expansion.

Question 15

How does external pressure affect venous return?

Answer 15

External pressure increases limb pressure, facilitating venous return by pushing fluid out of tissues.

Question 16

What law explains the relationship between tension, radius, and pressure in compression?

Answer 16

Laplace’s law

Question 17

What is the difference between short stretch and long stretch compression bandages?

Answer 17

• Short stretch bandages provide high pressure during movement and low pressure at rest.
• Long stretch bandages provide mild compression and lower working pressure.

Question 18

What is the advantage of multi-layer bandages over single-layer bandages?

Answer 18

Multi-layer bandages maintain a pressure gradient for a prolonged period and are recommended as first-line treatment for venous leg ulcers.

Question 19

What materials are used in paste bandages like Unna’s boot?

Answer 19

Paste bandages use gauze impregnated with zinc oxide, calamine, glycerin, and gelatin, forming a semi-rigid support.

Question 20

What are the characteristics of tubular bandages?

Answer 20

Tubular bandages provide graduated compression, but their generic shapes and sizes may not fit all patients and lose compression over time.

Question 21

What is the typical compression provided by compression stockings?

Answer 21

Compression stockings typically provide 8–50 mmHg, with pressure greatest at the ankle and decreasing superiorly.

• Used for long-term management

Question 22

What are Velcro compression garments, and what is their main advantage?

Answer 22

- Velcro compression garments are removable orthotic devices that provide sustained compression and are easy to apply.

- Disadvantages

• High one-time cost
• Need for patient adherence for daily wear

Question 23

What type of compression bandage is recommended for lymphedema management?

Answer 23

Short stretch bandages are commonly used for lymphedema as they work with the calf muscle pump.

Question 24

What are toe wraps, and what condition are they commonly used for?

Answer 24

Toe wraps provide compression for localized edema management, especially in toes and feet.

Question 25

What is the difference between flat-knit and circular-knit compression stockings?

Answer 25

* **Flat-knit** stockings are stiffer and better for lymphedema but more difficult to don. * **Circular-knit** stockings are less stiff and easier to apply.

Question 26

What is the purpose of anti-embolism stockings?

Answer 26

Anti-embolism stockings (16-18 mmHg) are used for non-ambulatory patients to prevent deep vein thrombosis and manage edema.

Question 27

How often should compression garments be replaced?

Answer 27

Compression garments should be replaced every 3–6 months.

Question 28

When should custom compression garments be used?

Answer 28

Custom garments are used when standard sizes do not fit or for patients with unique limb shapes or severe lymphedema.

Question 29

What are the compression levels for managing venous insufficiency and associated edema?

Answer 29

Low to moderate compression (25-35 mmHg) is used for edema secondary to venous insufficiency, while moderate to high compression (30-50 mmHg) is for persistent edema or lymphedema.

Question 30

What is the key feature of gradient compression stockings?

Answer 30

Gradient compression stockings exert the greatest pressure at the ankle, decreasing as they move upward.

Question 31

Why are donning aids recommended for compression garments?

Answer 31

Donning aids make it easier to apply compression garments, especially for patients with limited mobility.

Question 32

What type of compression stockings is suitable for long-term management of venous insufficiency?

Answer 32

Knee-high gradient compression stockings are generally sufficient for long-term management.

Question 33

What is the purpose of compression pumps in lymphedema management?

Answer 33

Compression pumps remove fluid from the area but do not remove protein, which can lead to fibrosis if not addressed.

Question 34

When are compression pumps recommended as an adjunct to manual lymph drainage?

Answer 34

Compression pumps are used when constant compression is not tolerated or manual lymph drainage is unavailable.

Question 35

What are intermittent pneumatic compression devices used for?

Answer 35

They stimulate venous return and are typically used for recalcitrant ulcers unresponsive to standard compression therapy.

Question 36

What is the recommended dosage for lymphedema treatment with compression pumps?

Answer 36

The recommended dosage is **45–60 minutes** at **30–60 mmHg sequential pressure**.

Question 37

What is the limitation of compression pumps in long-term edema management?

Answer 37

Residual protein after pump use can draw fluid back, necessitating additional treatments like manual lymph drainage.

Question 38

What insurance criteria must be met for intermittent pneumatic compression device coverage?

Answer 38

Patients must have a **recalcitrant ulcer for over 6 months and have received adequate compression therapy**.

Question 39

What patient factors should be considered when selecting a compression product?

Answer 39

* edema presence * venous return impairment * arterial perfusion adequacy * open wounds * limb shape

Question 40

How should compression therapy be adjusted for patients with arterial disease?

Answer 40

The degree of compression should be modified, with lower levels used to ensure tolerance.

Question 41

Why are leg elevation and calf muscle exercises recommended alongside compression therapy?

Answer 41

These interventions enhance venous return and complement the effects of compression.

Question 42

What type of compression is typically used for patients with significant drainage from wounds?

Answer 42

Products with absorptive inner layers, such as **multi-layer bandages**, are used to manage excess wound drainage.

Question 43

Indication / Compression * lymphedema = **?** * Moderate to severe UE lymphedema = **?** * Moderate to severe LE lymphedema = **?** * Stage 3 LE lymphedema = **?**

Answer 43

* **10–21 mmHg** = lymphedema * **15–32 mmHg** = Moderate to severe UE lymphedema * **30–40 mmHg** = Moderate to severe LE lymphedema * **< 40 mmHg** = Stage 3 LE lymphedema

Question 44

Pressure vs. Stiffness

Answer 44

**-** **Pressure**: force that is created by the elastic recoil of the product on the tissue * (Dosage (mmHg) / Resting pressure (IP) = Therapeutic Dosage **-** **Stiffness**: force that is created by the resistance to expansion of the product - Currently not stated. * Higher stiffness greater physiologic impact.