Compression Flashcards
What causes Edema?
Unregulated BP
Plasma proteins imbalance
Lymphatic flow obstruction
Venous insufficiency
What is edema?
Fluid in the extra-cellular tissue spaces
What is in lymphatic fluid?
Proteins, water, and macrophages
What causes systemic edema? (3)
CHF, hypoalbuminemia, kidney dysfuction
What kind of pattern systemic edema?
Broad, non-discerning edematous pattern
Consequences of Edema? (6)
Decreased ROM
Functional limitations
Decreased somatosensory input
Pain
Increased collagen leading to fibrosis
Ultimately may lead to contracture, increased risk of infection, amputation
Pitting edema scale
1+ Barely detectable depression when finger is depressed into the skin
2+ Slight indentation. 15 seconds to rebound
3+ Deeper indentation. 30 seconds to rebound
4+ > 30 seconds to rebound
What to be cautious about with the volumetric measurement of edema?
open wounds
What are 3 ways to reduce edema?
Improved venous and lymphatic circulation
Physical barrier to limit the size and shape of tissue
increased tissue temperature
What is some compression uses? (4)
reducing vascular or lymphatic edema
DVT prevention
Shaping of a residual limb following amputation
healing in venous insufficient wound areas
Contraindications for Compression? (9)
Trauma/fracture
Acute DVT
Completely obstructed lymph or venous return
Arterial disease/insufficiency
Acute pulmonary edema
Loss of sensation
Impaired cognition
Infection in treatment area
Hypoproteinemia (<2g/dL)
Precautions for Compression (3)
Decreased sensation
Malignancy
Uncontrolled hypertension
What kind of pressure in highly extensible bandages?
High resting pressure and low working pressure
Relatively inelastic bandages pressure?
low resting pressure, high working pressure
Cons of highly elastic bandages? (3)
- May slide down the extremity
- Difficult to apply even tension
- Quickly loose their elastic properties
Low Stretch Bandages Pro/Cons? (2/2)
+ Higher working pressure generated, rather than resting pressure (less likely to impede circulation)
+ More fool-proof for application of compressive forces
- Not as effective at removing edema as highly elastic bandages
- Less comfortable to wear than highly elastic bandages
Semi-Rigid Bandages Pros/cons? (2)
+ Useful for less compliant patients, as it remains in place for several days
+ Eliminates daily dressing changes
- Must be protected from the environment (shower)
- pressure areas if not correctly applied
Contraindications for Bandages? (5)
Patients with arterial disease (ABI < 0.8)
Patient inability to remove bandage (physical or mental)
Allergy to component
Active wound infection at bandage site
Active cellulitis at bandage site
Garments Contraindications? (2)
Patients with arterial disease
Allergy to component
Garments precautions? (1)
Not recommended for open wounds
Mechanical compression works by?
increase tissue temperature
Increase pressure in the interstitial spaces forces the fluid to move into the lymphatic and venous systems
When do you use Non-dynamic pump? (2)
Utilized for DVT prophylaxis in sedentary patients
Should be utilized any time the patient is not ambulating
What kind of pressure in dynamic pump?
Varying pressure, force applied and released cyclically
general guidelines for pumps (2)
Check patient’s blood pressure, BP determines device settings
Set inflation and deflation ratio to ~3:1 (generally for edema reduction, 45-90 seconds on/15-30 seconds off); to shape residual limb 4:1 often used
how long to wear pump if patient has lymphedema?
2-3 hours daily
what should not be felt when using a pump?
numbness, tingling, pulsating, or pain
Contrainindications for Pump (7)
DVT, thrombophlebitis
Acute cardiac failure
Obstructed lymphatic of venous flow
Arterial disease
Fracture
Local Infection
Significant hypoproteinemia- protein levels < 2 g/dl
Precautions for pumps? (6)
CHF
impaired sensation or mentation
Uncontrolled HTN
CVA
valve insufficiency
never adjust pressure greater than diastolic pressure
