IPC Flashcards
what is intermittent pneumatic compression (IPC)?
mechanical pump and sleeve used to deliver intermittent pneumatic compression
what are the indications for IPC?
edema control
improving venous circulation, prevention of VTE
healing venous stasis ulcers
reducing lymphedema
peripheral arterial insufficiency
treat sensory impairment after CVA
what is edema?
abnormal amount of fluid collects in the interstitial space
how does IPC for edema management work?
compression of tissue from edema elevates pressure of fluid in interstitial spaces to be higher than that of blood and lymph vessels
this change in pressure gradient may facilitate the flow of fluid out of the interstitial space back into the venous and lymphatic vessels for drainage
what are some causes of edema?
increased vascular permeability
acute phase of inflammation
venous obstruction
electrolyte/fluid imbalances
limb dependence
system (cardiac, renal, pulm)
t/f: fluid in jt results in pain and decreased ROM
true
why does decreased edema decrease pain?
bc when there is less volume in the joint, there is less stimulation of the baroreceptors and therefore a decreased pain response
t/f: fluid increases metabolic demands during ambulation and decreases fxnal capacity
true
IPC can be used in conjunction with ____ to reduce swelling/inflammation post injury and surgery
cryotherapy
t/f: in a study post-injury/surgery, they found that IPC was beneficial for edema and probably beneficial for pain and mobility
true
in a study on knee OA, did the IPC group have better, worse, or similar outcomes in terms of knee swelling to the control?
better
what is a common complication post-op?
VTE
t/f: there is a large body of evidence to support the use of IPC to prevent DVT
true
in addition to IPC, what is an essential prevention technique for DVT?
early mobilization
t/f: IPC is rendered as standard of care bedside with lower leg wraps attached to pump
truen
venous stasis ulcers are caused by what?
venous HTN resulting in valvular incompetence and/or obstruction of veins
what are some risks for developing venous stasis ulcers?
prolonged immobility (walking<200m/day)
obesity
calf ms pump insufficiency
IPC mimics what anatomic pump?
the GS ms pump
how does IPC help healing venous stasis ulcers?
IPC decreased venous pressure and interstitial edema, collapses superficial venous system, forcing blood into the deep system in distal to proximal compression
what prevents leaking of blood, fibrin, and protein from skin capillaries in IPC?
increase in subQ pressure
t/f: a study found that IPC accelerated wound closure from 60 days to 20 days with 70 mmHg over 20 sec and deflation for 20 sec for one hr/day
true
what does the literature say about IPC fast vs slow compression for healing venous stasis ulcers?
fast sequential IPC is more effective than slow regime for healing ulcers
what is fast sequential IPC?
0.5 sec compression rise time
6 sec inflation
12 sec deflation
what is slow IPC?
60 sec compression rise time
30 sec inflation/90 sec deflation ratio
t/f: a study found that there is limited evidence that IPC may improve healing when added to compression bandaging
true
t/f: it is clear from the research that IPC can be used instead of compression bandaging
false, it is unclear
multiple case studies support using IPC to control edema for venous stasis ulcer healing in what pts?
obese pts with misshapened legs that are difficult to compress effectively using bandages and stockings
what is an unna boot?
inelastic gauze impregnated with zinc oxide/calamine
a rigid dressing that restricts outward motion of the calf ms when the pt walks to direct force inward and mimic calf ms pumping action to improve venous flow
how long is an unna boot worn for?
3-5 days
for any pt with edema, what should we talk with them about?
compression stocking use
t/f: compression stockings must be prescription stockings
false, they can be prescription or over the counter
t/f: TKA using compression stockings show better healing than without them
true
what is the proposed mechanisms for reducing lymphedema with IPC?
IPC decreased capillary filtration, which decreased lymph formation
t/f: the evidence for IPC for lymphedema reduction is conflicting
true
why may studies show IPC to be ineffective for lymphedema reduction?
they may not have sufficient pressures to create proximal flow
the typical IPC pressures for lymphedema are 30-60 mmHg, but a study found that using what pressure if effective for stage 2-4 leg lymphedema?
50-120 mmHg
what are advanced compression devices?
IPC devices that produce rhythmical stimulation designed to move fluid from the limb toward the trunk
what may be more effective than traditional compression devices for lymphedema?
advanced compression devices
why may advanced compression devices be more effective for lymphedema management than traditional compression?
bc it uses gentler dynamic pressures intended to mobilize high-protein lymph fluid out of the limb rather than squeeze fluid into the venous system
t/f: advanced compression devices begin with the proximal treatment that progresses distally, with subsequent repetitive distal to proximal tx
true
is there significant differences in using IPC vs manual lymphatic drainage for lymphedema?
no
are there added benefits to using IPC in addition to CDT for lymphedema?
nope
what may be an added benefit of IPC with CDT for lymphedema, but not significant?
reduced sensations of heaviness and tightness
what disease is characterized by intermittent claudication and low fxn?
PAD
PAD worsens over time and leads to what?
critical limb ischemia and possible limb loss
how does IPC help PAD?
sequential IPC applied distal to proximal empties the capacitance vessels by expelling blood proximally reducing blood the pools in the sinuses around the valves
what are additional proposed effects of IPC for PAD?
chemical
nitric oxide production
increased pro-inflammatory agents that play a role in early phase of tissue healing
why is nitric oxide released with IPC?
the shear stresses on endothelial cells produced with IPC triggers its release
what does the literature say about HPIPC (high pressure IPC) for PAD?
that it is able to reduce wound surface size almost 20% more than surgery
greater pain relief and physical fxn
what is the difference bw arterial and venous pumps?
arterial pumps cover only the foot and calf with much higher pressures on the leg and shorter compression time
venous pumps cover the whole leg with lower pressures to the leg and longer compression/relaxation times
what does the literature say about IPC to enhance ms recovery after strenuous exercise?
anecdotal claims of enhanced ms recovery
studies show no improvement in ms performance
one study shows that there were lower blood lactate levels after 30 min of IPC 70mmHg
what are typical inflation pressures for IPC?
pressure above 30 mmHg (arterial capillary pressure)
it is generally accepted that inflation pressures should NOT exceed what?
diastolic BP minus 10 mmHg
are pressures for the UE or LE greater?
LE>UE
what is the typical range for UE pressures used in IPC?
30-60mmHg
what is the typical range for LE pressures used in IPC?
40-80mmHg
t/f: treatment of venous ulcers, PAD, lymphedema may need different pressures than typical UE/LE pressures in IPC
true
what is the typical on:off time for ratio of inflation time to deflation time in IPC?
recommendations vary
what is the most important determining factor for on/off times with IPC?
pt comfort
what is the typical tx time of IPC?
45-60 min
how many days/week should IPC be done?
daily
2x/day
3x/wk
what is lipodermatosclerosis?
when the infected limb appears to look like a tree trunk and feels like plastic
what can lipodermatosclerosis lead to?
cellulitis and if untreated, death
t/f: observation of lipdermatosclerosis in a pt is a red flag and grounds for referral out
true
what are the IPC precautions?
recent skin graft
acute local dermatologic infections
impaired sensation or mentation
why is recent skin graft a precaution for IPC?
bc application of IPC could interfere with adherence of the graft
why is acute local dermatologic infection a precaution for IPC?
bc contact with the stocking or IPC sleeve as well as perspiration can cause spread of infection
why is impaired sensation or mentation a precaution for IPC?
bc injury could occur
what are the contraindications for IPC?
acute pulmonary edema
CHF
recent or acute DVT
acute fx
uncontrolled HTN
IPC used to treat venous insufficiency when significant ischemia is present
why is acute pulmonary edema a contraindication to IPC?
application of IPC could return the interstitial edema back to the venous circulation, increasing the stress on the heart and lungs, which are already compromised
why is CHF a contraindication to IPC?
as with acute pulmonary edema, application of IPC can increase stress on the heart and lungs
why is recent or acute DVT a contraindication to IPC?
application of IPC to an area with DVT can cause the thrombus to dislodge from a vein wall, travel to the heart/lungs, and block an artery
why is acute fx a contraindication to IPC?
in cases of acute fx and unstable bone fx, changes in pressure could cause movt and delay healing
why is uncontrolled HTN a contraindication to IPC?
compression may elevate BP and increase vascular load to the heart
we should avoid IPC when ABI is below what?
0.5
we should use IPC with caution when ABI is bw what values?
0.5-0.8
what are the steps of IPC application (long ass list, just know generally)
Review pts hx, precaution/contraindications
Check sensation, cognition
Remove all jewelry/clothing in tx area
Expose and examine entire limb
BP, HR, RR for baseline, compare during/after tx and assist to establish max pressure
Circumferential measurements before/after
Empty bladder, fluid returning to circulation
Position pt, support, elevation
Appropriate covering of open wounds
Apply stockinette over limb, smooth out any wrinkles, plastic bad is wound is present
Apply sleeve, smallest sleeve that provides adequate coverage of tx area
Connect hoses to sleeve in proper sequence
Set appropriate parameters
Pt must be able to alert PT is discomfort or unusual sensations
Monitor VS during tx
End tx, turn pressure to 0, turn off power, remove sleeve, assess skin
what is involved in IPC post-tx?
Post tx circumferential measurements
Application of compression bandage or garment
Assist pt to sitting/standing
Slight dizziness, unsteadiness is common bc of circulatory changes and prolonged immobilization
Document tx intervention
t/f: following IPC tx, slight dizziness, unsteadiness is common bc of circulatory changes and prolonged immobilization
true
what s/s post IPC tx may indicate fluid overload and that they tx may not be right for the pt?
SOB
what may indicate DVT or nerve irritation?
numbness/tingling in distal extremity
if a pt complains of numbness/tingling with IPC, what should we do? why?
stop tx and assess bc it could be a DVT or nerves irritation
what is Hivamat/Chud?
deep oscillation therapy that uses electrostatic impulses to penetrate the effected tissue into vibrations causing a deep biological effect
what can Hivamat/Chud (deep oscillation therapy) be used for?
acute or chronic pain
chronic edema
lymphedema
lipedema
fibrosis
injuries
inflammation
burns
wound healing disorders
t/f: Physiomed claims that the chronic pain control uses the same concept as TENS with nociceptive control at 90-150 Hz with Hivamat
true
deep oscillation therapy can be used for what chronic pains?
fibromyalgia
lumbar pain
trauma
CRPS stage 1-2
epicondylitis
what are the contraindications to deep oscillation therapy? (long ass list)
Acute infections
Infectious skin diseases
Active tuberculosis
Hypersensitivity to electrostatic fields
Untreated malignant processes
Erysipelas (bacterial infection)
Acute inflammations with participation of pathogenic agents
Acute venous diseases (untreated thromboses)
Pts and therapists with cardiac pacemakers and other electronic implants
Untreated heart disorders and diseases, esp cardiac insufficiency, decompensated cardiac edema and cardiac arrhythmia
Pregnancy of the therapist or pts (bc it is electrostatic)
Vertebrobasilar insufficiency (VBI)
what are the key lymph nodes of the lymphatic system?
cervical, axillary, and inguinal nodes
what does the literature say about deep oscillation therapy?
it may help flexibility/ROM, Raynaud’s pain, or lymphatic drainage
