Edema Management and Compression Flashcards
Define Venous Edema
Excess protein poor interstitial fluid resulting from increased capillary permeability that cannot be accommodated by the normal lymphatic system
This is also known as tissue swelling, It is formed by the accumulation of inter-cellular fluid present in the tissues as a result of filtration of fluid from within the vascular system into the surrounding intersitial space
Edema
Your patient has heart failure. What could be a secondary complication?
Venous Edema
Other conditions: Chronic venous insufficiency, hepatic cirrhosis, nephritic syndrome, inflammatory wound healing response
Define Lymphedema
- Low output failure of the lymphatic system
- May be congenital or due to anatomical disruption such as surgical dissection or recurrent infection
Can your dx of your patient be edema?
No, it is a symptom of something else. Excess fluid in the tissues is a sx of an underlying condition
Name 5 of the 9 bilateral causes of edema
- ) Cardiac Disease
- ) Renal Disease
- ) Hepatic Disease
- ) GI Disease
- ) Immune disease and allergy
- ) Nutritional Disease
- ) Pregnancy
- ) Circulatory Problems (Vena Cava obstruction)
- ) Drugs and Medications
Name 3 of the 5 unilateral causes of edema
- ) Venous Disease
- ) Arterial Disease (AV fistula)
- ) Lymphatic Disease
- ) Operations
- ) Trauma
Your patient comes in with what looks like bilateral swollen legs. You are able to pinch the skin on the top of the foot. What is your hypothesis?
Lipedema: Abnormal accumulation of adipose tissue in the LE, can be mistaken for lymphedema, dorsum of the feet are spared
During the subjective interview and your screen what are some things you should be asking/looking for in a patient with edema?
- Adequate hx providing info regarding medical conditions that could cause edema
- Occupation
- Duration of edema
- BMI
- Edema Distribution
- Pitting
- Varicosities
- Skin Changes
- Color (Red may not mean infection)
- Measurement of the limb
What are some ways to treat edema?
- Leg elevation (should be at least around waist level)
- Exercise: Calf muscle pump
- Compression Therapy
What should you do before putting on bandages?
Evaluation of arterial circulation = Pulse exam (femoral, popliteal, dorsalis pedis, posterior tib)
-Also do doppler assessment (ABI)
What amount of compression is ideal for treatment of edema and venous stasis ulcers?
35-45 mmHg
Your patient is able to walk around in their bandage…what type of compression bandage would you use?
Inelastic (short stretch) bandage b/c pressure increases when the patient moves. This bandage doesn’t apply compression, doesn’t expand when the muscle contracts and is able to conform to the extremity. At rest pressure is 28 mmHg ( medium compression)
What type of compression is >60 mm Hg
Very strong Compression
What type of compression is 20-<40 mmHg
Medium Compresion
What type of compression is 40-<60 mmHg
Strong Compression
This type of compression provides grades compression from the ankle to below the knee.
Compression Stocking
Define the classes of compression stockings
Class 1: 14-19 mmHg
Class 2: 19-24 mmHg
Class 3: 25-35 mmHg
Class 4: 40-50 mmHg
Provide examples of single layer elastic compression bandages
-Ace Wrap
-Coban
(Provide mild compression)
These bandages are 2-4 layers and provide moderate to high compression
Multilateral elastic compression bandages
With this type of bandage pressure will decrease with movement, and example is the Unna Boot. Certain amount of pressure is applied to the extremity (ideal is 35-45 mmHg)
Long Stretch Compression Bandages
What is the purpose of using compression devices for edema reduction?
-Improves healing environment
-Reduces neuromuscular inhibition
-Improves ROM
-Decreases pain
Also, helps prevents DVT by increasing venous flow which prevents clots
This type of compression device inflates as a unit
Circumferntial Unit
If you want to inflate the compression unit and have it remain inflated…what would you call this
Constant Unit
Name at least 8 contraindications for use of a compression device
- ) Acute or unhealed fracture
- ) Uncontrolled Hypertension
- ) Compartment Syndrome
- ) Current PVD
- ) Arteriosclerosis
- ) Edema secondary to CHF
- ) Ischemic vascular disease
- ) Pulmonary edema
- ) Gangrene
- ) Dermatitis
- ) DVT
- Thrombophlebitits
When the unit milks from distal to proximal, chambers inflate individually
Sequential Unit
Air (pneumatic) or chilled water (hydraulic) are what type of unit?
Media Unit
Name the physiological effects of compression devices
- Mechanical pressure reduces edema
- Forces venous fluids proximally
- Decrease capillary filtration pressure, limiting formation of edema
- Increased lymphatic uptake
- Improved absorption and removal of solid wastes
- Increase ROM
- Decrease Pain
What are some things that can be done with compression therapy?
- Elevation of limb (gravity assists in venous and lymphatic return
- Electrical Stimulation: Motor level stimulation provides muscle pump
What step is out of order for Termination of the Treatment?
- ) Reduce the ON time or select the DRAIN mode to remove the air or fluid from the appliance
- ) Allow the appliance to deflate
- ) Remove body part
- ) Apply a compression wrap and any appropriate supportive device
- ) Re-measure circumference of extremity and determine amount of edema reduction
- ) Encourage patient to keep the limb elevated whenever possible between treatments
Step #5 is wrong, it should be step #4
- ) Reduce the ON time or select the DRAIN mode to remove the air or fluid from the appliance
- ) Allow the appliance to deflate
- ) Remove body part
- ) Re-measure circumference of extremity and determine amount of edema reduction
- ) Apply a compression wrap and any appropriate supportive device
- ) Encourage patient to keep the limb elevated whenever possible between treatments
What are the steps for initiation of compression therapy?
- ) Set TEMP between 50-55 F
- ) Select the MAX PRESSURE for tx.
- 30-60 mm Hg for UE and 60-80 for LE - ) Select the ON-OFF times
- 3:1 duty cycle is often used - ) Select TREATMENT TIME
- Post-traumatic edema: 20-30 minutes
- Lymphedema: Several hours
What things should you be instructing the patient on during/before the compression device starts?
- Inform pt about sensations to be expected
- Instruct pt to perform ROM exercises during the off cycle
- If sessions are longer then 60 minutes you must stop session and inspect extremity for proper capillary refill and sensation or the presence of unusual marking or unexpected pitting edema
Maintenance of the machine after each treatment includes what….
- Check for leaks/tears, if found repair with an approved patch kit or return to manufacture
- Clean the appliance using an approved cleaner
- If machine washable, turn them inside out and close them
Quarterly maintenance includes…
-Check air/water hoses, clean external unit, check plugs, cables and cords for frays etc
Annually or as required maintenance includles
A qualified technician should perform an inspection and calibration and perform any needed maintenance
Application of compression therapy includes
- Distal to Proximal
- Wrap medial to lateral with an initial figure 8
- Decrease tension moving proximally
- Avoid circumferential and spiral wrapping
- Assess capillary refill post application
