(DONE) Agents - Compression

primary clinical applications for compression

-prevent DVT

-facilitate healing of venous ulcers

-residual limb shaping

-scar control

-control of peripheral edema

fluid travels thru 3 major pathways

1. circulatory system

2. lymphatic system

3. interstitial spaces between cells

T/F: compression can be static or intermittent

true

T/F: compression can be applied uniformly or sequentially to a limb

true

fluid exchange at capillary occurs via __ & __ pressure

hydrostatic & osmotic

We (do/do not) treat systemic diseases with compression!

DO NOT!!!

fluid travels through what 3 major pathways

1. circulatory system

2. lymphatic system

3. interstitial spaces b/w cells

indications for intermittent pneumatic compression (IPC)

• edema

• prevention of DVT

• venous stasis ulcers

• lymphedema

in (normal//abnormal) edema, fluid leaks into interstitial space but is reabsorbed in venous or lymph system

normal

what things may cause abnormal edema?

-Venous/lymphatic obstruction or insufficiency

-Increased capillary permeability

-Immobility (airline travel)

-Pregnancy

-Increased plasma volume

-trauma, surgery, burns

-inflammation

do we do compression with congestive heart failure?

NO!

edema can lead to..

-delayed healing

-decr ROM

-decr function

-pain

-skin pigment and collagen changes

-contractures/deformities

-ulceration

-cellulitis

-incr risk of infection

T/F: edema causes permanent changes to collagen

TRUE

what is the brown pigment on legs common with venous insufficiency?

hemosiderin staining

3 ways to measure edema

-anthropometric measurements (REPRODUCIBLE landmarks)

-volumeter

-pitting edema scale

pitting edema is a ___ issue

venous

pitting edema scale

__% of patients undergoing orthopedic surgery will develop a venous thromboembolism without prophylactic (intended to prevent disease) interventions

80%

who's most at risk for DVT?

bedridden pt, paralysis, post-op, obesity, pregnancy

_________ increases blood flow, decreases venous stasis, and therefore decreases opportunity for clot to form

intermittent pneumatic compression (IPC)

best way to resolve venous insufficiency?

exercise!

____ therapy is the cornerstone of venous ulcer treatment!

COMPRESSION!!!

T/F: compression can improve venous circulation and rate of healing of venous stasis ulcers

TRUE!

risks for venous stasis ulcers

• prolonged immobility

• obesity

• calf muscle pump dysfunction

• pregnancy

valve incompetence and/or obstruction of vein →______

venous HTN, a condition associated with venous stasis ulcers

for venous stasis ulcer compression therapy, is it best to use a single layer of compression or multiple

multiple

static compression can also be used for.... (2)

-limb shaping

-hypertrophic scarring (compression reduces scar formation by increasing collagenase activity)

T/F: static compression decreases contractures in hypertrophic scarring

TRUE

precautions for IPC

-recent skin graft

-acute local dermatologic infection

-impaired sensation

-impaired mentation

contraindications for IPC

-arterial insufficiency

-uncontrolled HTN

-DVT or PE

-obstructed venous return

-CHF

-acute pulmonary edema

-malignancy

-acute trauma/fx

-arterial revascularization

can we do IPC on a patient with ABI less than .6?

NO!!!! CONTRAINDICATED

can we do IPC on a patient with ABI greater than .8?

YES!! FULL COMPRESSION

potential adverse effects

-incr edema

-impaired circulation

-ischemia

-peripheral n injury

-incr cardiac load

why might ted hose INCREASE edema???

pts doing activities and moving around, they bunch up in areas and cut off circulation and make edema WORSE

(sequential/uniform) compression device is thought to provide more effective "milking" than single chamber compression sleeves

SEQUENTIAL

bandages apply ____ OR ____ pressure

resting // working

___ pressure is exerted by elastic when it is put on stretch

resting (ace bandage)

___ pressure is produced by active muscles pushing against inelastic bandages

working (only works if patient can move!)

for resting pressure, use (high/low) stretch bandage

HIGH!!

for working pressure, use (high/low) stretch bandage

LOW!!!

why do high stretch bandages provide little to no working pressure?

they have some give when muscle expands

(high//low) stretch bandages are most effective on immobile patients

high

tubigrip and ace wraps are examples of (high//low) stretch bandages and will be used for (resting//working) pressure

HIGH // RESTING

durelast is an examples of (high//low) stretch bandage and will be used for (resting//working) pressure

LOW // WORKING

(high//low) stretch bandages do not work in flaccid or inactive limbs

LOW!!!

TED hose (thrombo-embolic stockings) provide what pressure?

moderate resting AND working

how long to wear TED hose?

24 hrs a day