Transcript Compression Devices - Therapeutic Modalities

Compression Devices
Purposes
Edema reduction
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Improves healing
environment
Reduces neuromuscular
inhibition
Improves range of motion
Decreases pain
Prevention of deep vein
thrombosis
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Increasing venous flow
prevents clot formation
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Types of Units
Circumferential
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Inflates as a unit
Constant
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Inflates and remains inflated
Intermittent
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Cycles off and on
Sequential
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Milks from distal to proximal
Chambers inflate individually
Media
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Air (pneumatic)
Chilled water (hydraulic)
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Sequential Compression
Physiological Effects
Mechanical pressure
reduces edema
Forces venous fluids
proximally
Decreases capillary
filtration pressure, limiting
formation of edema
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Constant compression
devices used in the acute
setting
Efficacy relative to simple
elevation has not been
substantiated
© 2005 - FA Davis
Physiological Effects
Increased lymphatic
uptake
Lymphatic system
consists of “buds”
Spreads exudate
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Comes into contact
with more buds
Improved absorption
and removal of solid
wastes
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Lymphatic Buds
Physiological Effects
Range of Motion
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Reduced fluid from the joint
Prevents arthrogentic muscle inhibition
Decreased fluid improves joint motion
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Decreases hydraulic pressure
Pain
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Decreased fluid decreases mechanical pain
Decrease pressure on nerve endings
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Improved vascular function decreases chemical pain
Improved blood/oxygen supply
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Contraindications
Possibility of an unhealed fracture
Compartment syndromes
Current peripheral vascular disease
Arteriosclerosis
Edema secondary to congestive heart failure
Ischemic vascular disease
Gangrene
Dermatitis
Deep vein thrombosis
Thrombophlebotis
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Precautions
The pressure applied should not exceed
the diastolic blood pressure
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Upper extremity: 40 to 60 mm Hg
Lower extremity: 60 to 100 mm Hg
Too much pressure may result in ischemia
Wrinkling of underlying Stockinette may
result in high-pressure areas.
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Clinical Application of
Intermittent Compression
Instrumentation
Power: Turns the unit on or off.
Temperature: Adjusts the temperature of the fluid.
Pressure: Adjusts the amount of compression in
millimeters of mercury (mm Hg) applied to the extremity.
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This value should not exceed the patient’s diastolic blood
pressure.
On-off time: Controls the proportion of the time that the
compression is on and off.
Pump: Turns on the pressure to the appliance.
Drain: Removes the pressure and deflates the
appliance.
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Preparation of the Treatment
Establish the absence of contraindications.
Remove any jewelry on the extremity being treated.
Determine the patient’s diastolic blood pressure.
Note the girth measurement of the body part being treated.
Cover the area to be treated with Stockinette™ or similar material.
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Care must be taken to ensure that this inner layer is free of wrinkles.
Select the appropriate appliance for the extremity being treated.
Insert the injured limb into the appliance.
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When full-length appliances are used, avoid bunching the garment in
the axilla or groin.
For best results, elevate the limb during treatment.
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Inflate fluid-filled units before elevating the body part.
Connect the appliance to the compression unit.
© 2005 - FA Davis
Initiation of the Treatment
If applicable, set the TEMPERATURE to be used, generally between 50°
and 55°F.
Select the maximal PRESSURE for the treatment. Normal pressure ranges:
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40 to 60 mm Hg for the upper extremity
60 to 100 mm Hg for the lower extremity
Select the ON-OFF times.
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A 3:1 duty cycle (e.g., 45 seconds ON, 15 seconds OFF) is often used
Effects of these ratios has not been substantiated
Select the appropriate TREATMENT TIME.
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Post-traumatic edema: 20 to 30 minutes.
Lymphedema: several hours.
Inform the individual about the sensations to be expected during the
treatment.
Instruct the patient to perform gentle range-of-motion (ROM) exercises
during the off cycle, if appropriate:
If long-term treatments (i.e., more than 60 consecutive minutes) are being
administered, regularly interrupt the session and inspect the extremity being
treated for proper capillary refill and sensation or the presence of unusual
marking or unexpected pitting edema.
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Alternate Applications
Elevate the extremity
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Gravity assists in
venous/lymphatic
return
Electrical Stimulation
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Motor-level stimulation
provides muscle pump
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Termination of the Treatment
Reduce the ON time or select the DRAIN mode
to remove the air or fluid from the appliance.
Allow the appliance to deflate
Gently remove the body part from the appliance.
Remeasure the circumference of the extremity
and determine the amount of edema reduction.
Apply a compression wrap and any appropriate
supportive devices.
Encourage the patient to keep the limb elevated
whenever possible between treatments.
© 2005 - FA Davis
Typical Maintenance
FOLLOWING EACH TREATMENT
Check the appliance for tears or leaks.
If a defect is found:
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Repair the defect with an approved patch kit
Return the appliance to the manufacturer for repair or discard the appliance.
Clean the appliance using an approved cleanser.
If appliances are machine washable, turn them inside out and close them.
Some appliances can be sterilized using gas systems.
QUARTERLY OR AS INDICATED
Check air/water hoses for defects and replace if necessary.
Clean the external unit using an approved cleanser.
Check the plugs, cables, and cords for knicks, frays, or other visible
damage.
ANNUALLY OR AS REQUIRED
A qualified service technician should perform an inspection and calibration
and perform any needed maintenance.
© 2005 - FA Davis