VCU DPT - Agents (Compression)

_________ is an inward directed mechanical force that increases pressure on body

compression

can compression be...

- static OR intermittent

- applied uniformly OR sequentially to a limb

yes and yes

primary clinical applications for compression (5)

prevent DVT

help venous ulcer healing

residual limb shaping

scar control

peripheral edema control

what 3 pathways does fluid normally move through

circulatory system

lymphatic system

interstitial space between cells

fluid exhcnage at the capillary occurs via ___________ and _______

hydrostatic and osmotic pressure

edema, DVT prevention, venous static ulcers, and lymphedema are all indications for _________

compression

t/f: we treat systemic diseases with compresion

FALSE

we do NOT

we ___(do/do not)______ treat systemic diseases with compression

do not

with normal edema fluid leaks into the _______ but is reabsorbed by ______

with abnormal edema, what are some things that could happen

interstitial space, venous/lymph

venous/lymph insuffieceincy

increased capillary permeability

immobility

increased plasma volume

what are some side effects of edema

decreased ROM and function

delayed healing

pain

collagen deposition

etc

what are three ways to measure edema

anthropometric measurements

- must be taken at reproducible landmarks

volumeter (water)

pitting edema

pitting edema scale:

what is grade for someone who has slight indentation, takes 15 seconds to rebound

2+

pitting edema scale:

what is grade for someone with barely detectable impression when finger pressed into skin

1+

pitting edema scale:

what is grade for someone with deeper indentation, taking 30 seconds to rebound

3+

pitting edema scale:

what is grade for someone with 30+ seconds to rebound

4+

what is pitting edema grade scale from, which is worse

1+, 2+, 3+, 4+

4+ is worst

pitting edema is a ______ issue

venous

80% of patients would develop a DVT without any intervention, largely in part to immobility

what can we do to help

compression!!!

compression for edema can help WHY

we can change the pressure to have an external force increasing osmotic pressure, getting fluid to return into venous/lyphm systems

early mobilization is

CRITICAL

______% of patients undergoing ortho sx will develop a DVt of some kind without interventions

80%

that is a LOT

compression:

a. ____ blood flow

b. _______ venous stasis

c. _______ chance to form clot

a. increase

b. decrease

c. lowers

what happens to create venous insuffeciny

normal and abnormal valves in venous/lympahtic vessels, and relation to backflow

what is the BEST PUMP to return venous/lymph fluids

physical activity with muscular contractions

the best pump to return venous and lymph fluids is

exercise

venous statis ulcers happen due to what

what are some risks (4)

valve incompentence, vein obstruction

immobility

obesity

lack of muscle pump or dysfunction

pregnancy

________ is the cornerstone of venous ulcer treatment

compression

compression can:

1. ____ venous circulation

2. _____ rate of healing venous stasis ulcers

increase

increase

with venous ulcers, compression is best if it is ___(multilayered/single layered)_____

multi

mod-high or low compression recommened for venous ulcer

mod-high (40-60 mmHg)

can static compression be used for limb shaping

yes

after amputation, to reduce and shape residual limb

can also help prepare limb for prosthetic

t/f: static compression helps with hypertrophic scarring

if true: how

if false: what type of scarring does it help with

true

reduces scar formation, increasing collagenase activity

decreases contractures

if using static compression for hypertrophic scarring, how much pressure should be used and for how long per day

20-30 mmHg

23 hours a day

do we treat edema due to congestive heart fai,ure with compression

NO!!! we do not treat systemic diseases

some precautions to compression (4)

recent skin graft

skin infection

impaired sensation

impaired mentation

contraindications to compression (5)

(there are a few others but very similar to this list)

arterial insuffeciency

uncontrolled HTN

DVT

CHF or other systemic issues

fracture

with compression and arterial insuffeciency....

an ABI < 0.06 = _________

an ABI of 0.06 - 0.8 = ___________

an ABI of >0.8 = _________

contraindicated

reducded compression, 27 mmHg or less

full compression allowed

5 potential adverse effects of compression

increased edema

impaired circulation

ischemia

peripheral nn injury

increased cardiac load

potential adverse effects of compression include

- _______ edema

- ________ circulation

- __________

- ___________ nerve injury

- ________ cardiac load

- INCREASED edema

- DECREASED circulation

- ISCHEMIA

- PERIPHERAL nerve injury

- INCREASED cardiac load

what is the issue with stockings for compression

get really bunched up, can make it worse

also difficult to even put on

what device is thought to do the best job at "milking" for compression

sequential intermittent compression devices

____________ throught to provide more effective milking effect than single chamber compression sleeves

sequential intermittment compression devices

describe how a sequential intermittment device works

it starts low, and then will squeeze up your leg

- simiarly to recreating blood flow

"milking" effect

with static compression, bandages apply a _______ or ______ pressure

difference is in type of band you use

working or resting

static compression applies what two types of pressures

which one is made with a elastic band, and which is with an inelastic band

resting pressure (elastic band)

working pressure (inelastic band)

with static compression, describe:

working pressure

resting pressure

working pressure: active muscles squeezing against a INELASTIC bandages

resting pressure: ELASTIC bandages pressing on muscles due to their stretch

______ pressure is provided with static compression because of ELASTIC bandages being put on stretch and squeezing muscles

resting

________ pressure is provided with static compression because of muscles contracting against INELASTIC bandages

working

working pressure only works if patient has _________

some mobility

- need this because it happens with muscles contracting and pushing on bands

for resting pressure, use ___(high/low)_____ stretch bandages

for working pressure, use ___(high/low)_____ stretch bandages

resting:

high

working:

low

why is high stretch bandage not good for giving working pressure

as the muscle contracts and moves, the bandage does too

with resting pressure, you use high stretch bandages

exerts ______ mmHg of pressure

60-70

when you are moving around but want some static compression, should you use high stretch or low stretch

and what pressure does this make

low stretch

working

when you are sitting around by want some static compression, should you use high stretch or low stretch

and what pressure does this make

high stretch

resting

is

a. resting pressure/high stretch

or

b. working pressure/low stretch

best for immobile patients

A

stocking and garments:

what type of pressure do they apply

how long do you wear

is pressure consistent or graded

both working and resting

24 hours a day

graded (more at distal)