Compression

Question 1

Compression

Answer 1

A mechanical force that increases external pressure on the body or body parts

Question 2

Effects of compression

Answer 2

• improves venous and lymphatic circulation
• spreads the edema over a larger area
• limits shape and size of tissue

Question 3

Edema

Answer 3

Presence of abnormal amounts of fluid in the extracellular tissue space of the body

Question 4

Indications

Answer 4

• lymphedema
• traumatize edema
• chronic edema
• static ulcer
• arterial insufficiency (intermittent claudicaciones)
• wound healing following surgery (prevent DVT)
• dialysis patient that develop edema in extremities
• swelling from limb amputation

Question 5

Treatments for edema

Answer 5

1. Elevation: assist with lymph flow
2. Compression: moves lymph along and spreads the intercellular edema over a larger area to enable more lymph capillaries to work to remove plasma proteins (massage, elastic/static, intermittent)
3. Weight bearing exercises: stimulate the venous pump
4. Cryotherapy: vasoconstriction

Question 6

Venous system

Answer 6

Purpose is to bring de-oxygenated blood from the periphery towards the heart
- venous return is facilitated via muscle contraction and opening and closing of venous valves, which creates a pumping action and moves blood from periphery to central circulation

Question 7

Plasma proteins

Answer 7

Plasma proteins flow out of the venous system due to hydrostatic pressure and flow into vessels due to osmotic pressure

Question 8

Causes of venous insufficiency

Answer 8

1. Treatable conditions
   - lack of activity, sedentary lifestyles
   - professions which require long periods of standing
   - degeneration of venous valves
   - inflammation of venous valves (phlebitis)
   - venous obstruction (partial vs. complete)
2. Non-treatable conditions
   - CHF
   - renal or liver failure
   - radiation damage

Question 9

Chronic venous insufficiency S&S

Answer 9

1. Common complaints: tingling, itching, heaviness in legs, cramping
2. Color changes: reddish brown
3. Skin changes: swelling, flakey, dry skin; pitting edema
4. Wounds: irregularly shaped, more superficial, medial aspect of lower leg
5. Temperature: normal to touch

Question 10

Venous insufficiency:

1. Aggravating factors
2. Alleviating factors
3. Treatment options

Answer 10

1. Standing, walking, and increased activity; dependen positioning to effects of gravity
2. Rest and elevation
3. IPC, compression garments, elevation, retrograde massage and activity as tolerated

Question 11

Potential complications of chronic venous insufficiency

Answer 11

• loss of ROM, pain, and decreased fucntion
• skin contractures, severe deformity of limb
• venous ulceration
• infection (cellulitis)
• amputation (gangrene, necrosis)
• DVT

Question 12

Arterial insufficiency S&S

Answer 12

1. Common omplaints: pain, cramping, P&N, increased with activity
2. Color change: bluish, white discoloration
3. Skin changes: thing and shiny with loss of hair; decrease or loss of pedal pulses
4. Wounds: usually smooth edges, deep and located on lateral aspect of lower leg
5. Temperature: cool to touch

Question 13

Arterial insufficiency:

1. Aggravating factors
2. Alleviating factors
3. Treatment options

Answer 13

1. Pain with activity, walking, and pain with elevation (claudicación)
2. Alleviating factors: usually alleviated with rest
3. Treatment options: maintinaing circulaiton (pharmacological)

Question 14

Lymphatic system

Answer 14

• the fluids and proteins that accumulate in the intersistial space is circulated by the lymphatic system and flushed out of the body by the kidneys
• homeostasis of the extracellular environment is maintained by the lymphatic system
• lymph vessels also rely on mm contraction and valve opening/closing (no pump)
• lymph nodes are concentrated in the axillary, groin (inguinal), throat and para-aortic arch (near spleen)

Question 15

Pic

Answer 15

Pic

Question 16

Causes of lymphedema

Answer 16

• low plasma proteins
• removal of lymph nodes
• abnormal vessel disctribution
• decreased activity
• congenital factors
• venous insufficiency
• lymphatic obstruction due to: infection, trauma, neoplasm, radiation rx, surgery, lipedema

Question 17

Lymphatic insufficiency S&S

Answer 17

1. Common complaints: pain, but not specific to activity
2. Color changes: none
3. Skin changes: pitting edema, which can become hard/fibrotic if prolonged
4. Wounds: infection/wounds usually occur suddenly
5. Temperature: normal

Question 18

Lymphatic insufficiency:

1. Aggravating factors
2. Alleviating factors
3. Treatment options

Answer 18

1. No specific factors/activities
2. ?
3. Intermittent pneumatic compression, compression garment (24/7), combined decongestive therapy, lymphatic drainage (specialty massage), keeping active within tolerance

Question 19

Negative effects of edema accumulation

Answer 19

• increases the distance that the nutrients and oxygen needs to travel to nourish remaining cells in injury area
• physical separation of torn tissue ends = pain and limited joint ROM
• increased recovery time = if persists: limited funciton, infection, mm atrophy, joint contractures, interstitial fibrosis, and reflex sympathetic dystrophy

Question 20

Compresssion reduces edema

Answer 20

Increases hydrostatic pressure outside of blood vessels, allowing fluid inside the vessels to circulate

Question 21

Law of Laplace

Answer 21

P = T/R

The pressure applied is inversely proportional to the radius

Question 22

Effects of compression

Answer 22

• improves venous and lymphatic circulation
• treat and control peripheral edema
• prevents formation of DVTs
• treatment of venous stasis ulcers
• helps shape residual limb before prosthetic fitting
• helps to decrease excessive scar tissue formation

Question 23

Types of compression

Answer 23

1. Intermittent (IPC)
   - prevent DVTs
   - decrease edema
   - prevent and/or treat venous stasis ulcers
2. Static (elastic wrap/custom fitted elastic garments)
   - helps with hypertrophic scar formation
   - used in conjuction with IPC between sessions to control and maintain edema reduction
   - helps shape a residual limb
   - DVT prevention (later)

Question 24

Compression garments

Answer 24

• pressure ranges 10-50mmHg
• hypertrophic scar prevention: 20-30mmHg
• control LE edema: 30-40mmHg

Question 25

Compression bandaging

Answer 25

- long stretch bandage extends 100-200% - short / low stretch stretches 30-90% - multi-layered systems use combo with 2-4 layers over each other

Question 26

Parameters for IPC

Answer 26

- inflation/deflation ratio 3:1 - inflation/deflation time 80-100 sec/25-50 sec - inflation pressure UE 30-60mmHg and LE 40-80mmHg - inflation pressure should never exceed a patient’s diastolic BP - avg recommended tx time: 3-4 hrs/rx, 1-2x/day but variable

Question 27

Compression exam and assessment

Answer 27

- always assess a pt’s BP before, during, and after tax - examine skin integrity and review PMH to ensure compression is appropriate - review contras and precautions - measure a pt’s girth (swelling) pre and post treatment to gauge treatment response - after compression sleeves are removed, one should wrap the area with elastic wrap to help maintain the reduction

Question 28

Precautions for IPC

Answer 28

1. Treated wound infection 2. Moderate to mild arterial disease (0.5-0.89) combined with venous insufficiency (mixed etiology) 3. Compression therapy followin vascular surgery, such as an arterial bypass graft, must be ordered by a vascular surgeon 4. The presence of neuropathy 5. Controlled heart, liver, or renal failure 6. Sever pain or untreated pain 7. Treated DVT or phlebitis

Question 29

Contras

Answer 29

1. Severe arterial disease unless the client is under the care of a vascular surgeon or physician 2. Untreated wound infection 3. Ischemic rest pain 4. Untreated DVT or phlebitis 5. Uncontrolled organ failure (heart, renal, liver) 6. Clients who are not able to manage compression due to cognitive impairment, mental health concerns, or a lack of support to put on a remove compression therapy systems

Question 30

Pt edu for compression

Answer 30

- Tx for edema can take several months to a year with consistent, continual follow-up care. There is a significant time commitment and requires high pt compliance! - a compression garment will usually be fitted to the pt for use between IPC tx to control edema between sessions - during tx, due to increase load of the vascular system, pt may need to urinate more frequently - typically, edema related to venous or lymphatic causes will be an ongoing problem with the need for frequent monitoring. The majority of pts will usually need some type of lifelong management (compression device)

Question 31

Research supports

Answer 31

- cryotherapy in combination with intermittent compression = best results for reduction of postacurte injry edema - increase in lymph flow on initiation of massage decreases of a 10 min period - clinical studies show significant gains in limbs volume reduction after 30 minutes of compression