Compression

What is the intended of effect of External Compression?

limiting the shape and size of a tissue/tissue formation

In what instances can compression be used?

• residual limbs

• burns

• edema

What are the adverse consequences of edema?

• limited ROM

• can cause collagen to be laid down

• increases risk of infections

• chronic cases can lead to cellulitis, ulceration, and amputation

What are indications for the use of compression?

• prevent DVT

• venous stasis ulcer management

• limb reshaping post-amputation

• control hypertrophic scarring

What are the contraindications for compression?

• cardiovascular issues

  • determines if increased fluid shift will be detrimental or not

  • monitor patient response

• heart failure or pulmonary edema

  • shift of fluid from peripheral to central circulation may increase stress on an already failing organ

• recent DVT, thrombophlebitis, or pulmonary embolism

  • may dislodge thrombus or help embolus travel

  • mitigate with TED hose? (varying pressure at different points on the leg)

• obstructed lymphatic or venous return (can cause burst)

• severe PAD or ulcers from arterial insufficiency

• acute local skin infection

• significant hypoproteinemia

• acute trauma or fx

What is something to be cautious of when removing compression garments?

harming delicate/fragile/healing skin

What are the adverse effects of compression?

• can aggravate a condition causing edema rather than improving

• too much pressure can cause ischemia and edema

What are precautions for compression?

• cancer

• CVA or significant cerebrovascular insufficiency

• area of superficial peripheral nerve

• impaired sensation or mentation

• uncontrolled HTN

When should compression garments be fitted?

when edema is minimal

When should compression garments be worn?

all the time except for bathing if pt can’t address edema themselves

What is an intermittent pneumatic compression pump?

a tool to reduce chronic or post-traumatic edema

• suitable for home use

• can be used in conjunction with static compression

• do not exceed diastolic BP for higher levels of compression

• usually used in hospitals

• becoming popular now (“tech boots”)

Where is fluid always pushed when applying compression?

towards the heart

What is recommended pressure for compression?

• treatment of UE = 30-60mmHg

• treatment of LE = 40-80mmHg

• time: from 30min to 4 hrs based on Dx

• frequency = 3x/wk 4x/day (longer times are for lymphedema)