What are the indications for compression therapy?
- Lymphedema- edema due to obstruction of the lymphatics, often LE, due to failure of lymphatic system to return it’s own fluid
- Postmastectomy lymphedema: disturbance in lymphatic circulation due to a radical mastectomy
- Varicose veins: when veins are continuously overstretched and pooling stasis of the blood results
- Edema secondary to cast removal: body part can’t swell when in cast, removing cast may cause edema b/c muscles not working well enough to move the fluid
- Stasis ulcers: often people have varicose veins or diabetes
- Postphlebitic venous insufficiency: after phlebitis the vein may be damaged and edema may occur
- Stasis dermatitis: Inflammation of the skin due to poor circulation
- Post amputation
What are treatments for lymphedema?
- elevation
- intermittent compression
- massage
- exercise
- eventually compression garments
What are treatments for postmastectomy lymphedema?
- intermittent compression
- pressure gradient garment for arm
- ROM exercises to prevent joint impairment
- massage
- elevation
What are the treatments for varicose veins?
- elevation
- bedrest
- weight reduction
- intermittent compression
- compression garments
What are the treatments for edema secondary to cast removal?
- intermittent compression
- massage
- ROM exercises
- strengthening exercises
What are the treatments for stasis ulcers?
- compression garments
- weight loss
- and elevation
- avoid standing for long periods of time
What are compression therapy treatments?
- Compression/cold combination devices
- compression bandages and wraps
- Compression garments
- intermittent compression devices
What is the lymphatic system?
removes excess proteins that have escaped from blood vessels and return it back to the blood via the main lymph ducts
What is edema?
an accumulation of excess fluids in the spaces between the cells of the tissues (interstitial space)
What is venous edema?
edema that results from increase capillary pressure and venous obstruction. Usually soft, pitting edema. Skin is often taught and glossy.
What is generalized edema?
caused by a systemic process due to chronic illness such as advanced cardiac disease, kidney failure or liver disease (often the groin, abdomen and LEs)
What is localized edema?
edema confined to an area, caused by venous or lymphatic obstruction; or to increased vascular permeability due to trauma or infection
What are the physiological effects of intermittent compression on the cardiopulmonary system?
- forces fluid out of the interstitial spaces to aid in venous return
- allows a sufficient amount of blood to return to heart for it to circulate through arterial system
- pumping forces fluid into the venous/lymphatic system and inflammation and edema reduced in area
- spreads intercellular edema over a larger area and lymph can remove plasma proteins and water
- circulation increases, wast flushed out, nutrition supplied to cells and healing process improves which decreases chance of tissue necrosis
What are the physiological effects of intermittent compression on the Endocrine system?
- compression allows increased transport of hormones throughout circulation
What are the physiological effects of intermittent compression on the integumentary system?
- severe edema can lead to paresthesias (abnormal sensation; prickling, tingling). Improvement in cutaneous sensation may occur
What are the physiological effects of intermittent compression on the musculoskeletal system?
- increase ROM
2. Decrease edema with decrease in nerve compression and increase in flow of nutrients to nerve and muscle tissue.
What are the physiological effects of intermittent compression on the peripheral vascular/lymph system?
- increase hydrostatic pressure of tissues, allowing absorption of interstitial fluids into venous and lymph
- Promotes homeostatic balance of osmotic and hydrostatic pressures in capillaries
What are the parameters you can change in intermittent compression?
- inflation pressure
- on-off time sequence
- total treatment time
What should the inflation pressures be for intermittent compression?
Recommended inflation: 30-60 mmHg for UE
40-80 mmHg for LE
***Stay below diastolic blood pressure in order to not occlude the arterial blood supply
What should the on/off times be with intermittent compression?
Lymphatic massage: shorter on/off times recommended
Decreased venous flow: longer on times are indicated
Lymphedema:
15-20 seconds on/ 3-6 seconds off
30 seconds on/ 30 seconds off
up to 4 minutes on/ one minute off
What is the total treatment time of intermittent compression?
30 min to 8 hours
For PT treatment: 30-60 minutes
What are other areas to note when doing intermittent compression?
- Pt should have stockinette directly over skin
- Take BP before treatment
- To initially inflate appliance set unit to apply pressure continuously –> increase pressure to tolerance
- During off cycles have pt move fingers, ankle, toes
- Remove sleeve hourly to check skin and allow some exercise
- at end of treatment remove sleeve, inspect skin, take BP, and measure extremity
- to retain reduction wrap in elastic wrap or compression garment
Where should you measure for an UE treatment?
- PIP
- Palmar crease
- wrist
- 6” below elbow
- 3” below elbow
- elbow
- 3” above elbow
- 6” above elbow
- 9” above elbow
Axilla
Where should you measure for a LE treatment?
MTP Plantar arch Heel 10" below knee 5" below knee Patella 5" above knee 10" above knee
