Compression Therapy (wk 4) Flashcards
How is homeostasis of vessel fluid maintained?
maintained through hydrostatic and osmotic pressure inside and outside the vessels
In normal circumstances hydrostatic is (=/>) osmotic forcing movement of fluid ____
hydrostatic is > osmotic, forcing small amounts of fluid into interstitium
What is edema?
excess fluid in the extra-cellular tissue spaces of the body
What can lead to edema?
- Venous insufficiency
- lymphatic abnormalities
- plasma proteins imbalance
- unregulated BP
Localized edema tends to occur in discrete areas of the body in conditions such as:
- venous insufficiency
- lymphatic blockage
- prolonged dependency (pregnant women)
- localized inflammation (sprained ankle)
Systemic edema, typically a more broad, and non-discerning edematous pattern, is associated with what conditions?
systemic conditions such as
- CHF (back up of blood returning to hear)
- hypoalbuminemia (decreased osmotic pressure)
- kidney dysfunction
What are consequences of edema?
- Decreased ROM
- Functional limitations
- Decreased somatosensory input
- Pain
- Increased collagen leading to fibrosis
- Ultimately may lead to contracture, increased risk of infection, amputation
T/F Pitting edema tends to be associated with new onset, acute symptoms
False, Softer thickening tends to be associated with new onset, acute symptoms
- Pitting edema is thick and slow moving. An indentation remains following removal of pressure source
What are the measurements of pitting edema: 1+ 2+ 3+ 4+
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
Two ways to measure volumetric change cause by edema?
- Volumetric water displacement
- Linear measurement
- > compare to uninvolved side
Edema reduction affected by what 3 means?
- Improved venous and lymphatic circulation
- Physical barrier to limit the size and shape of tissue
- Increased tissue temperature
What are uses of compression to help with edema?
- increase venous and lymph return
- DVT prevention
- Shaping residual limb
- facilitate healing in venous insufficient wound areas
- daily to counteract effect of gravity on vascular and lymph systems
Contraindication or precaution of compression for edema: decreased sensation
precaution
Contraindication or precaution of compression for edema: Trauma/fractuere
Contraindication
Contraindication or precaution of compression for edema: acute dvt
Contraindication
Contraindication or precaution of compression for edema: completely obstructed lymph or venous return
Contraindication
Contraindication or precaution of compression for edema: malignancy
precaution
Contraindication or precaution of compression for edema: arterial disease/insufficiency
Contraindication
Contraindication or precaution of compression for edema: arterial revascularization
Contraindication
Contraindication or precaution of compression for edema: uncontrolled HTN
precaution
Contraindication or precaution of compression for edema: acute pulmonary edema
Contraindication
Contraindication or precaution of compression for edema: loss of sensation
Contraindication
Contraindication or precaution of compression for edema: edema with cardiac or renal impairment
Contraindication
Contraindication or precaution of compression for edema: impaired cognition
Contraindication
Contraindication or precaution of compression for edema: Over area of superficial peripheral nerve
precaution
Contraindication or precaution of compression for edema: infection in treatment area
Contraindication
Contraindication or precaution of compression for edema: Hypoproteinemia (<2g/dL)
Contraindication
Two types of compression?
- Static- Exerting a continuous or constant force
- Intermittent- Exerting a varying force over time
- This type is thought to provide improved outcomes through a milking mechanism from distal to proximal
T/F Greater compression forces proximally and decrease moving distally.
False, greater compression forces in the distal extremity and gradually decreasing proximally, aiding in circulatory return
What is resting pressure?
applied when elastic properties of the bandage are stretched in application.
This pressure remains whether patient moves or remains still
What is working pressure?
produced by muscle activity of movement pushing against the restraining bandage.
Highly extensible bandages offer what type of resting and working pressures?
high resting pressures when stretched with application, but typically provide very low working pressure
(ace bandage)
relatively inelastic bandages offer what type of resting and working pressures?
low resting pressure, but high working pressure
Pros of highly elastic bandages?
+ Inexpensive
+ Readily Available
+ Easily Removed
+ Patient/Caregiver can be trained to install
Cons of highly elastic bandages?
- Correct and Incorrect Application
- May slide down the extremity
- Difficult to apply even tension
- Quickly lose their elastic properties
- Requires patient to be able to reach area to be wrapped/unwrapped if they do not have a caregiver to help
Pros of low stretch bandages?
+ Higher working pressure generated, rather than resting pressure (less likely to impede circulation)
+ Still relatively inexpensive
+ Easily Removed
+ Patient/Caregiver can be trained to install
+ More fool-proof for application of compressive forces (not as much give)
Cons of low stretch bandages?
- Not as effective at removing edema as highly elastic bandages
- Less comfortable to wear than highly elastic bandages
- Correct and Incorrect Application
- Requires patient to be able to reach area to be wrapped/unwrapped
- Less readily available than highly elastic
How often do you apply semi-rigid bandages?
Apply every 4-7 days to extremity after edema has been removed by other means
Pros of semi-rigid bandages?
+ Useful for less compliant patients, in place for several days
+ Eliminates daily dressing changes
Cons of semi-rigid bandages?
- Must be protected from environment (shower)
- Long term applications allows for pressure areas if not correctly applied
- Patient may be unable to remove easily if discomfort occurs
2 Precautions when using bandages for edema?
- Propensity to be discharging to facility unfamiliar with use of multi-layer dressing
- Frail skin / Bony prominences
Contraindications of using bandages for edema?
- Patients with arterial disease (ABI < 0.8)
- ABI = compare BP at ankle to BP at brachium
- Low = blockage in leg (strength in body is not equal)
- Should be .9 - Patient inability to remove bandage (physical or mental)
- Allergy to component
- Active wound infection at bandage site
- Active cellulitis (infection of skin) at bandage site
Pros of custom compressive garments:
+ OTC and Custom-fit Available
+ Last 4-9 months with proper care
+ Provide Graded Compression
+ Cosmetically Acceptable
Cons of custom compressive garments:
- Can be difficult to don, especially with arthritic hands
- Costly and not universally covered item by 3rd party payers
2 Precautions of using compressive garments:
- May be difficult to don, may require an assistant or assistive aids
- Not recommended for over open wounds
2 contraindications of using compressive garments:
- Patients with arterial disease
2. Allergy to component
Mechanical compression pumps decreased interstitial fluids by:
- Increase pressure -> forcing the fluid to move into the lymphatic and venous systems
- Increase local tissue temp -> allowing improved activity of temperature dependent enzymes (e.g. collagenase – wound healing)
Two types of intermittent pneumatic pumps:
- Non-dynamic (static)
2. Dynamic
Non-dynamic (static) intermittent pneumatic pumps -
Same pressure throughout surface being compressed, force applied and released cyclically
When are Non-dynamic (static) intermittent pneumatic pumps utilized?
- DVT prophylaxis in sedentary patients
2. Patient not ambulating
T/F Can ambulate wearing a Non-dynamic (static) intermittent pneumatic pump
False, must be removed for ambulation
Dynamic intermittent pneumatic pumps -
- Varying pressure throughout surface being compressed, force applied and released cyclically
- peak pressure distally -> moves proximally in wave action
Pumps general guidelines:
Why do you need to check the patient’s BP before using?
need BP > so can overcome pressure
Pumps general guidelines:
Inflation/deflation ratio for edema =
Inflation/deflation ratio for residual limb shaping =
Inflation/deflation ratio for edema = 3:1
Inflation/deflation ratio for residual limb shaping = 4:1
T/F Numbness, tingling, pulsating, or pain will be felt during treatment of pumps.
False SHOULD NOT BE FELT
Precautions or contraindication of pumps:
CHF patient must be monitored closely for signs of intravascular fluid burden
Precautions
Precautions or contraindication of pumps:
Impaired sensation or mentation
Precautions
Precautions or contraindication of pumps:
DVT, thrombophlebitis
contraindication
Precautions or contraindication of pumps:
Acute cardiac failure
contraindication
Precautions or contraindication of pumps:
Uncontrolled HTN
Precautions
Precautions or contraindication of pumps:
Obstructed lymphatic of venous flow
contraindication
Precautions or contraindication of pumps:
CA
Precautions
Precautions or contraindication of pumps:
CVA
Precautions
Precautions or contraindication of pumps:
Arterial disease
contraindication
Precautions or contraindication of pumps:
Fracture
contraindication
Precautions or contraindication of pumps:
Valve insufficiency
Precautions
Precautions or contraindication of pumps:
Superficial peripheral nerves
Precautions
Precautions or contraindication of pumps:
Local infection
contraindication
Precautions or contraindication of pumps:
Requires barrier for patients with Contact Isolation Precautions
Precautions
Precautions or contraindication of pumps:
Significant hypoproteinemia- protein levels < 2 g/dl
contraindication
Precautions or contraindication of pumps:
Never adjust pressure to greater than diastolic blood pressure
Precautions
Precautions or contraindication of pumps:
Suspected underlying syndrome which may be affected by compression (compartment syndrome)
contraindication
