Compression Therapy: Garments & Pumps

Question 1

garments

Answer 1

• pt must be measured and fitted for custom garment, some over the counter available
• available in varying levels of compression

Question 2

when are garments applied

Answer 2

as needed after edema has been removed by other means

Question 3

pros of compressive garments

Answer 3

OTC and custom fit available
last 4-9 months with proper care
provided graded compression
cosmetically acceptable

Question 4

cons of compressive garments

Answer 4

difficult to don, especially with arthritic hands

costly and not universailly covered item by 3rd party payers

Question 5

precautions for garments

Answer 5

may need assistance to don

not good over open wounds

Question 6

contraindications for garments

Answer 6

patients with arterial disease

allergy to component

Question 7

mechanical compression

Answer 7

decreases interstitial fluids

Question 8

how does mechanical compression decrease interstitial fluids

Answer 8

• increase pressure in the interstitial spaces forcing the fluid to move into the lymphatic and venous systems
• fluid then circulates rather than accumulates
• maintaining a mechanical limit to the skin or surrounding tissue through a sleeve to limit leaking
• increased local tissue temp, improved activity of enzymes

Question 9

non-dynamic intermittent pneumatic pumps (static)

Answer 9

• same pressure throughout surface being compressed, force applied and released cyclically

Question 10

when is non-dynamic intermittent pneumatic pumps

Answer 10

• DVT prophylaxis in sedentary pt

- any time the pt isn’t ambulating

Question 11

important to remember for non-dynamic intermittent pneumatic pumps

Answer 11

• remove for ambulation
• calf length or thigh length
• routine care in hospital for non-ambulatory

Question 12

dynamic intermittent pneumatic pumps

Answer 12

varying pressure throughout surface being compressed, force applied and released cyclically

Question 13

how do dynamic sequntial compression devices work

Answer 13

• available in multi-chamber sleeve designs
• peak pressure first develops distally
• progresses proximally in wave action, decreasing pressue in each subsequent chamber
• completes wave then holds comlpete deflation cycle

Question 14

how long are dynamic sequntial compression devices cycles

Answer 14

every 7-8 seconds

Question 15

general guidelines for pumps

Answer 15

check pt’s BP

set inflation and deflation ratio 3:1 for edema(45-90:15-30secs), 4:1 to shape residual limb

Question 16

what determines the device setting in pumps

Answer 16

pt’s BP

Question 17

lymphedema treatment time for pumps

Answer 17

2 hrs progressing to two 3 hr sessions daily

Question 18

traumatic edema treatment time for pumps

Answer 18

2 hrs daily

Question 19

venous ulcers treatment time for pumps

Answer 19

2.5 hrs, 3x/week progressing to 2 hrs daily

Question 20

residual limb edema treatment time for pumps

Answer 20

1 hr progressing to 3x1hr daily sessions

Question 21

what should not be felt during treatment with a pump

Answer 21

numbness, tingling, pulsating or pain

Question 22

precautions for pumps

Answer 22

• CHF pt must be monitored for signs of intravascular fluid burden
• impaired sensation or mentation
• uncontrolled HTN
• CA
• CVA
• valve insufficiency
• superficial peripheral nerves
• requires barrier for pt with contact isolation precautions
• never adjust pressure to greater than diastolic BP

Question 23

contraindications for pumps

Answer 23

• DVT, thrombophlebitis
• acute cardiac failure
• obstructed lymphatic of venous flow
• arterial disease
• fx
• local infxn
• significant hypoprotenemia - pro levels < 2g/dl
• suspected underlying syndrome which may be effected by compression like compartment syndrome