Transcript Compression Devices - Therapeutic Modalities

Compression Devices
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Purposes
• Edema reduction
– Improves healing
environment
– Reduces neuromuscular
inhibition
– Improves range of motion
– Decreases pain
• Prevention of deep vein
thrombosis
– Increasing venous flow
prevents clot formation
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Types of Units
• Circumferential
– Inflates as a unit
• Constant
– Inflates and remains inflated
• Intermittent
– Cycles off and on
• Sequential
– Milks from distal to proximal
– Chambers inflate individually
• Media
– Air (pneumatic)
– Chilled water (hydraulic)
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Sequential Compression
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Physiological Effects
• Mechanical pressure
reduces edema
• Forces venous fluids
proximally
• Decreases capillary
filtration pressure, limiting
formation of edema
– Constant compression
devices used in the acute
setting
– Efficacy relative to simple
elevation has not been
substantiated
© 2005 – FA Davis, Inc.
Physiological Effects
• Increased lymphatic
uptake
• Lymphatic system
consists of “buds”
• Spreads exudate
– Comes into contact
with more buds
• Improved absorption
and removal of solid
wastes
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Lymphatic Buds
Physiological Effects
• Range of Motion
– Reduced fluid from the joint
• Prevents arthrogentic muscle inhibition
• Decreased fluid improves joint motion
– Decreases hydraulic pressure
• Pain
– Decreased fluid decreases mechanical pain
• Decrease pressure on nerve endings
– Improved vascular function decreases chemical pain
• Improved blood/oxygen supply
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Contraindications
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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
– 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
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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.
– 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
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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.
– 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.
– When full-length appliances are used, avoid bunching the garment in
the axilla or groin.
• For best results, elevate the limb during treatment.
– Inflate fluid-filled units before elevating the body part.
• Connect the appliance to the compression unit.
© 2005 – FA Davis, Inc.
Initiation of the Treatment
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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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Select the ON-OFF times.
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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:
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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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40 to 60 mm Hg for the upper extremity
60 to 100 mm Hg for the lower extremity
Wiggle the fingers (upper extremity treatments) or toes (lower extremity treatments).
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
– Gravity assists in
venous/lymphatic
return
• Electrical Stimulation
– 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, Inc.
Typical Maintenance
• Disconnect the compression unit from the electrical power source prior to cleaning.
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, Inc.