Compression & Lymphedema KEY POINTS PT 632

What is LaPlace's Law?

pressure is directly proportional to tension and layers, and inversely proportional to width and limb radius

What is an example of how LaPlace's law applies to compression bandage dressing?

the smallest circumference of the limb has the HIGHEST PRESSURE when bandage is applied with a constant force (pressure is inversely related to radius or circumference)

The pressure under a compression bandage depends on what 3 things?

1. how hard you pull

2. how many layers you apply

3. how big the limb is

compression is NOT low risk! start with lower pressures and increase as tolerated.

More pull = ?

More layers = ?

Bigger limb = ?

Smaller limb = ?

More pull = MORE PRESSURE (tension)

More layers = MORE PRESSURE

Bigger limb = LESS PRESSURE

Smaller limb = MORE PRESSURE

When applying a compression bandage to someone's leg, how should the pressure gradient be set-up?

pressure gradient should be from DISTAL to PROXIMAL (meaning that you may need to add layers, width, or padding to change the limb radius)

i.e. add a higher tension (more layers) down at the toes and a lower tension (less layers) as you move up the legs

Where do wound dressings go when compression wrapping?

below the wrapping, the skin needs to be protected with a moisture barrier

When the fluid volume is stable in the body, you can start to transition to what?

compression garments to maintain the stable fluid volume

An ideal compression bandage to promote fluid movement has..

HIGH working pressure

LOW resting pressure

A long stretch/high resting pressure bandage is used for what?

- used for non-ambulatory individuals

- require frequent dressing change

- individuals with rapid volume changes that require frequent re-wrapping

A long stretch/high resting pressure bandage is best used where?

at a facility where staff can do the wrapping

When can you NOT wear a long stretch/high resting pressure compression bandage?

you cannot wear it overnight a it creates a mild tourniquet effect and can impact blood flow

A short stretch/high working pressure compression bandage is used when?

used for ambulatory patients IN CONJUNCTION with manual lymphatic drainage and exercise (typically is apart of a 2-3 multilayer bandage system)

How long do can you wear a short stretch/high working pressure compression bandage?

for up to 5 days and can be worn overnight

What are 3 key aspects of lymphedema?

1. unilateral of asymmetric appearance

2. Stemmer's sign (can't pinch finger/toe)

3. can use lymphatic scintigraphy (used to map how lymphatic fluid is draining and can be used to find the sentinel lymph node in CA)

What is Peau d'orange?

skin looks like an orange peel d/t lymphatic drainage OR inflammatory breast cancer (need to refer for medical evaluation if it doesn't match medical history)

What are watersheds and using light manual traction good for?

used to open lymphatic vessels and move lymph away from the normal lymph pathways (watersheds) towards areas with functional lymph nodes

When performing light manual skin traction, where do you start?

start with opening proximal areas, and then working the individual limb segments distal to proximal

With an individual with lymphedema, patient education on protecting the skin and limb from what sort of things is very beneficial?

- sunburn

- injury

- heat/hot water

- bug bites

- animal scratches

- IVs

- blood pressure

- compression with high altitude

When the lymph nodes are removed, what stage lymphedema is this?

stage 0 lymphedema

True/False: compression stays on during appropriately graded exercise.

TRUE! compression should stay on when performing appropriately dosed exercise

A compression pump for lymphedema needs to be...

specifically designed for the patient

What are examples of HIGH RISK upper extremity activity for someone with lymphedema?

- gardening

- tennis/racquet sports

- golf

- shoveling snow

- moving furniture

- carrying luggage/grocery bags

- weight lifting

- intense gripping of reins when horse riding

What are examples of MEDIUM RISK upper extremity activity for someone with lymphedema?

- jogging/running

- biking (rec. to use aerogrip bars)

- stair master (when gripping bars on side of machine)

- norditrac

- general weight lifting of rest of body

- easy horse riding (hold the reins loosely)

What are examples of BENEFICIAL upper extremity activity for someone with lymphedema?

- swimming

- lymphedema exercise program walking

- stair master w/o gripping (can elevate arms sometimes)

- self MLD

- yoga

- water aerobics

What are examples of HIGH RISK lower extremity activity for someone with lymphedema?

- running

- intense biking

- moving furniture

- soccer

- hockey

- sitting or standing or long time

- weight lifting with legs

- stairmaster >15 mins

- wrestling

- intense horse riding

What are examples of MEDIUM RISK lower extremity activity for someone with lymphedema?

- light jogging

- biking >30 mins

- skating >20 mins

- golfing

- weight lifting

- norditrac >15 mins

- stairmaster >5 mins

- volleyball/tennis

What are examples of BENEFICIAL lower extremity activity for someone with lymphedema?

- walking

- easy biking 10-20 mins

- lymphedema exercise

- easy skating 10-15 mins

- calf pumps norditrac 5-10 mins

- deep breathing exercises

- yoga

- water aerobics

What are advantages of using an inelastic (unna boot) compression for lymphedema? Disadvantages?

- high working pressure

- well tolerated during rest

is messy

very high stiffness + trained staff need to put on + may stay for some days

What are advantages and disadvantages of using a single component short-stretch wrap?

- high working pressure

- well tolerated during rest

- Comprilan and Putter are washable and reusable

- slippage adhesive and cohesive materials are not reusable

high stiffness + trained staff need to put on + may stay for some days

What are advantages and disadvantages of using a multi component inelastic compression?

- high working pressure

- well tolerated during rest

- less slippage

- non-adhesive, non-cohesive are washable and reusable

- cohesive materials not reusable

high stiffness + trained staff need to put on + may stay for some days

What are advantages and disadvantages of using a multi-component long-stretch compression?

- high working pressure

- well tolerated during rest

- not reusable

- bulky and warm

high stiffness + trained staff need to put on + may stay for some days

What are advantages and disadvantages of using a single component long-stretch wrap elastic?

- self application

- low working pressure

- not tolerated when applied with high pressure

low stiffness + easy application + needs to be removed overnight

What are advantages and disadvantages of using compression stockings, elastic, or round knitted compressions?

- pt can shower daily

- daily skin care and self management

- low working pressure

- difficult donning

low stiffness + self-application

What are advantages and disadvantages of using ulcer stockings?

- pt can shower daily

- daily skin care and self management

- difficulty donning

medium stiffness + base layer stays to keep ulcer-dressing in place + second stocking during day time

What are advantages and disadvantages of using flat knitted compression stockings?

- shape distortion

- pt can shower, daily skin care, and self-management

- thicker and difficulty donning

medium stiffness + self-application

What are advantages and disadvantages of using short stretch velcro devices?

- pt can have showers, skin care, and self-management

- not visually appealing

medium/high stiffness + self-application + self-adjustable

What are advantages and disadvantages of using an extremity pump?

- pts can have showers, daily skin care, and self-management

- works when pt is resting for only limited time

- adjunctive use

high stiffness + self-application + self-adjustable