CSkills 2 - Compression

What is external compression

Inward-directed mechanical force that increases external pressure on the body or body part

What are the general considerations for compression

- Fluid balance

- Peripheral edema

- Deep vein thrombosis

How does compression improve fluid balance

It improves it by increasing hydrostatic pressure in interstitial space, which increases pressure outside of vessels causing limited reverse fluid flow. This allows for fluid to circulate and not accumulate

For clinical application, peripheral edema is the

Primary reason

Compression can be applied for prevention of

DVTs

Effects of external compression includes

- Improved venous and lymphatic circulation

- Limits shape and size of tissue

- Increased tissue temperature

Intermittent compression may improve circulation more effectively than

Static

External compression may facilitate healing of

Venous statis ulcers

Static compression garments or bandaging can help limit

Shape and size of new tissue growth

How does external pressure increase tissue temperature

Tissue temp increase is not a direct effect of compression, but an increase of enzyme activity that breaks down excessive scar tissue

What are the clinical indications of compression

- Edema

- DVT prevention

- Venous statis ulcers

- Residual limb shaping

- Control of hypertrophic scarring

Edema is swelling that is caused by

Increased fluid in the interstital spaces in the body

Edema formation can be caused by

- Systemic illness

- Exercise/trauma/burns/ infections

- Immobility

- Venous insufficiency

- Pregnancy

Would static or intermittent compression be better for residual limb shaping

Static

How does hydrostatic pressure differ from oncotic pressure

Hydrostatic pressure is the flow OUT of vessels and oncotic pressure is the flow INTO vessels

In a healthy body, hydrostatic pressure should be _ compared to oncotic pressure

Higher

Adverse effects of edema can lead to

- Restricted ROM

- Pain

- DIsfigurement

- Infection

- Ulceration

- Amputation

- Itching

- Brown skin pigmentation

- Functional impairment

How does compression help reduce edema

It counter balances increased oncotic or hydrostatic pressure which allows fluid to flow out of vessels into extravascular space

What are the symptoms of post-thrombotic syndrome

- Pain

- Swelling

- Local skin changes

Compression does not treat DVT, but rather it

Helps to prevent it

How does compression help prevent DVT

It helps increase circulation

The effects of compression for DVT prevention is greatest when combined with

Other forms of DVT prevention

What is a venous stasis ulcer

Area of tissue breakdown and necrosis occuring in areas of impaired venous circulation

What is the gold standard for treatment/prevention of a venous stasis ulcer

- Compression

- Multi-layered compression

- Adding exercise to compression

How does compression help with venous stasis ulcers

- Facilitates healing

- Reduce venous pooling/reflux

- Improving tissue oxygenation

- Altering white cell adhesion

- Reducing edema

Intermittent compression reduces residual limb in how much time compared to other techniques

Half the time

Temporary prosthesis may achieve ideal stump shaping more quickly than

Compression bandaging or pneumatic compression

Compression controls

Post surgical edema and soft tissue stretching

What is hypertrophic scarring

Excessive scarring within boundaries of original site of injury

Hypertrophic scars are

Not pliable, have a raised edge appearance, and do not have clearly identifiable skin layers

What are keloids

A form of excessive scarring that extent beyond the boundaries of the original injury site

How do keloids differ from hypertrophic scarring

Keloids extend outside the boundaries of the original site of injury while hypertrophic scars stay within the boundaries

What are the parameters for hypertrophic scar control with compression

- Compression of 20-30 mmHg

- 23-24 hours/day

- 12+ months

What are the contraindications of compression ( AA SOCAL CASA UE)

- Arterial revascularization

- ABI < 0.6 avoid static compression

- Severe peripheral arterial disease

- Obstructed lymphatic or venous return

- Cardiac/pulmonary edema

- Acute fracture or other trauma

- Limb movement is avoided

- Cancer

- Acute infections

- Significant hyperproteinemia (<2g/dL)

- Acute DVT

- Underlying cause unknown

- Extremes of age

What are the precautions of compression (SAD ICU RN)

- Superficial peripheral nerves

- ABI between 0.5-0.8

- Dermatologic infection

- Impaired sensation or mentation

- Cancer

- Uncontrolled hypertension

- Recent skin graft

- Neuropathy (monitor for ischemia)

Adverse effects of compression generally relates to

Aggravating a condition that is causing edema or is impairing circulation if excessive pressure is used

What are examples of conditions that might be exacerbated by compression

- Heart failure

- Liver failure

- Kidney failure

- Circulatory obstruction

If fluid accumulates at the proximal end of a limb, you should

Mobiize the area using massage

What are the general steps for application of compression

1. Evaluate patient

2. Determine appropriateness and safety

3. Select appropriate form of compression

4. Explain procedure and rationale to patient

5. Apply compression

6. Assess outcome whn treatment is complete

7. Clean up and document

What is resting pressure

Pressure exerted by elastic when it is put on stretch

What is working pressure

Pressure produced by active muscles pushing against an inelastic bandage

What is a long-stretch bandage

High resting pressure at around 60-70 mmHg

What is a short stretch bandage?

High working pressure