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623: Physical Agents & Mech Modalities > Compression > Flashcards

Compression Flashcards

1
Q

What is Compression?

A

The application of a mechanical force that increases the external pressure on the body or body part

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2
Q

Compression is generally used to do what?

A
  • Control peripheral edema caused by vascular or lymphatic dysfunction
  • Improve fluid balance and circulation
  • Prevent formation of DVTs
  • Facilitate residual limb shaping after amputation
  • Modify scar formation
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3
Q

How does compression improved fluid balance?

A

It increases hydrostatic pressure in the interstitial space, which means the fluid in the vessels is circulated rather than pooled

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4
Q

2 Edema classsifications

A
  • Lymphatic edema

- Venous edema

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5
Q

Lymphatic edema vs. Venous edema

A

Lymphatic edema occurs when plasma proteins in the tissues stagnate owing to mechanical insufficiency of lymphatic drainage
Venous edema results from increased capillary pressure and venous obstruction

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6
Q

How is normal fluid equilibrium in the tissues maintained?

A

By the balance between hydrostatic and osmotic pressures inside and outside of the blood vessels

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7
Q

Higher hydrostatic pressure inside the vessels acts to push fluid ___ of the vessels

A

OUT

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8
Q

Higher protein concentration and osmotic pressure inside the vessels act to keep fluid _____ the vessels

A

INSIDE

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9
Q

Which is higher, hydrostatic or osmotic pressure? What does this result in?

A

Hydrostatic pressure which results in a slight loss of fluid into the interstitial space

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10
Q

The interstitial fluid is taken up and returned to the venous system via what?

A

the lymphatic system

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11
Q

3 effects of external compression

A
  • Improve venous and lymphatic circulation
  • Limits the shape and size of tissue
  • Increases tissue temperature
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12
Q

How does compression improve venous and lymphatic circulation?

A
  • By increasing the hydrostatic pressure in the interstitial space
  • By limiting the outflow of fluid from vessels into the interstitial space
  • By milking” the fluids from the tissues
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13
Q

8 major causes of edema

A
  • Venous or lymphatic obstruction or insufficiency
  • Increased capillary permeability
  • Increased plasma volume due to sodium/water retention
  • After trauma, surgery or burns
  • With infections
  • After exercise
  • Airplane travel
  • Pregnancy
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14
Q

6 other causes of edema

A
  • Congestive heart failure
  • Liver failure
  • Acute renal disease
  • Diabetic glomerulonephritis
  • Malnutrition
  • Radiation injury
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15
Q

What is the primary factor propelling lymphatic and venous flow?

A

Muscle contractions

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16
Q

What 3 things cause venous insufficiency?

A
  • Lack of physical activity
  • Degenerated valves
  • Mechanical obstruction of the veins by a tumor or inflammation
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17
Q

What is phlebitis?

A

Inflammation of the veins

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18
Q

How does phlebitis increase hydrostatic pressure?

A

By the thickening and loss of elasticity of vessel walls

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19
Q

What 2 things does phlebitis result in?

A
  • Decreased circulation of deoxygenated blood out of the veins and increased venous pressure
  • Dependent position further increases hydrostatic pressure
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20
Q

3 unique characteristics of venous edema

A
  • Generally it is a soft pitting edema
  • It has a tendency to pool in the distal extremities
  • The skin has a glossy, shiny appearance
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21
Q

What is lymphedema?

A

It is a condition of localized fluid retention and tissue swelling caused by a compromised lymphatic system

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22
Q

What is the most common cause of venous or lymphatic edema?

A

Infection

23
Q

What is the result as plasma proteins are laid down in the tissues over time?

A

subcutaneous tissue fibrosis and hard induration of the skin

24
Q

Most effective therapeutic treatment of edema

A

Low pulse rate electrical stimulation accompanied by elevation

25
Q

Mechanical compression devices should be pumped up to __ - __ mm Hg for the UE and __ - __ mm Hg for the LE

A

30-60 mmHg

40-80 mmHg

26
Q

Treatment on-off time ratios for compression devices should be either _:1 or _:1 with at least __ second off time recommended

A

5:1 or 2:1

10 second

27
Q

Total treatment time for compression varies from __ - __ minutes

A

10-60

can also be as long as 3 hours long

28
Q

4 uses of compression

A
  • Prevention of DVT
  • Venous stasis ulcers
  • Residual limb shaping
  • Control of hypertrophic scarring
29
Q

10 risk factors of DVT

A
  • Age
  • Surgery or trauma
  • Confinement to bed
  • Cancer
  • Central vein catheterization
  • Prior superficial vein thrombosis
  • Varicose veins
  • Paralysis
  • Oral contraceptives
  • Pregnancy
  • Hormone therapy
30
Q

5 treatment approaches to prevent DVTs

A
  • Compression stockings
  • Intermittent pneumatic compression
  • Gastroc/soleus exercises
  • Calf muscle E-stim
  • Anticoagulant medications
31
Q

How does compression reduce DVT formation?

A

It improves venous flow which reduces venous stasis and thrombus formation

32
Q

What are venous stasis ulcers?

A

Areas of tissue breakdown and necrosis that occur in areas of impaired venous circulation

33
Q

What causes venous stasis ulcers?

A

As venous pressure increases venous circulation is impaired which leads to endovascular and inflammatory changes which provide a setting for ulcer formation

34
Q

How does compression affect the formation of venous stasis ulcers?

A
  • Improves venous circulation
  • Reduces the adverse effects of poor venous flow
  • Diminishes the risk of vascular ulcer formation
  • Facilitates healing of previously formed ulcers
35
Q

Should intermittent or static compression be used in residual limb shaping?

A

Intermittent compression has been shown to reduce the residual limb in half the time required by other techniques

36
Q

Describe hypertrophic scars

A

They are not pliable and are raised and ridged in appearance

37
Q

The risk of hypertrophic scarring increases with what 6 things?

A
  • Delayed healing
  • Deep wounds
  • Repeated trauma
  • Infection
  • Presence of a foreign body
  • Genetic predisposition
38
Q

8 Contraindications to Compression

A
  • Heart failure or pulmonary edema
  • Recent or acute DVT, thrombophlebitis, or PE
  • Obstructed lymphatic or venous return
  • Severe peripheral arterial disease and/or ulcers due to arterial insufficiency
  • Acute local skin infection
  • Significant Hypoproteinemia (protein levels <2 gm/dL)
  • Acute trauma or fracture
  • Arterial revascularization
39
Q

5 Precautions for Compression

A
  • Impaired sensation or mentation
  • Uncontrolled hypertension
  • Cancer
  • Stroke or significant cerebrovascular insufficiency
  • Superficial peripheral nerves
40
Q

Compression bandages work in what 2 ways?

A

They apply working or resting pressure

 - Resting pressure is exerted by elastic when it is put on stretch
 - Working pressure is produced by active muscles pushing against an inelastic bandage
41
Q

A long-stretch bandage applies how much pressure?

A

60 - 70 mmHg

42
Q

Examples of long-stretch bandages

A

Ace wraps and Tubigrip

43
Q

When should short-stretch bandages be used?

A

Most useful during exercise, however they do not control edema effectively

44
Q

Example of a short-stretch bandage

A

Comprilan

45
Q

What is a Unna boot?

A

a special gauze bandage, which can be used for the treatment of venous stasis ulcers

46
Q

How much pressure should antiembolism stockings produce?

A

16-18 mmHg

47
Q

How much pressure should stockings for scar tissue control produce?

A

20-30 mmHg

48
Q

How much pressure should stockings for edema control produce?

A

30-40 mmHg

49
Q

Intermittent compression devices help mostly with what?

A

edema reduction

50
Q

Static compression devices help mostly with what?

A

the maintenance of edema reversal

51
Q

Are intermittent compression devices used for control of scar formation?

A

NO

52
Q

Should a patient with venous insufficiency use intermittent compression?

A

only after the patient has tried compression stockings for 6 months, with unsuccessful results

53
Q

What should the inflation/deflation time be for edema, DVT prevention, and venous stasis ulcers?

A

80-100/25-35 seconds

at a 3:1 ratio

54
Q

What should the inflation/deflation time be for residual limb reduction?

A

40-60/10-15 seconds

at a 4:1 ratio

623: Physical Agents & Mech Modalities (17 decks)

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