Compression

“inward-directed mechanical force that increases pressure on body”

what is compression

true

T/F: compression can be static or dynamic/intermittent

• prevention of DVT

• healing of venous ulcers

• residual limb shaping

• scar control

• peripheral edema

We typically use compression on what type of patients?

1. circulatory system 

2. lymphatic system 

3. interstitial spaces b/w cells 

Fluid travels thru 3 major pathways which are what 

capillary

Fluid exchange at the ______ occurs via hydrostatic and osmotic pressure

healthy systems!!

Normal flow of fluid is dependent on __________ (and a bunch of other things hehe)

• edema

• DVT prevention 

• venous statis ulcers

• lymphedema 

why would we use IPC

FALSE

T/F: we can treat systemic diseases with compression

interstitial, lymph

Normal edema is when there is fluid flowing between ______ but it is resorbed in the venous or ____ systems

imbalance

Abnormal edema =

obstruction, permeability, inflammatory process

Abnormal Edema might be caused by venous/lymphatic _____ or insufficiency, increased capillary _________, imobility, pregnancy, increased plasma volume, trauma/surgery/burns/infections, and ______

Edema 

_______ can lead to the follow:

• delayed healing

• decreased ROM + function 

• pain 

• skin pigment + collagen changes

• contractures/deformities 

• ulceration 

• cellulitis 

• increased risk of infection 

1. anthropometric (at reproducible landmarks) 

2. volumeter

3. pitting edema (4 stages) 

3 ways to measure edema:

Pitting Edema Scale

________ allows us to quantify edema based on how much time it takes for the skin to rebound

• 1+ : barely detectable impression when pressed

• 2+ : slight indentation, 15s

• 3+ : deeper indentation, 30s

• 4+ : >30s 

external force increases osmotic pressure to promote fluid return 

why compression for edema

TRUE

T/F: 80% of patients undergoing orthopedic sx will develop VTE without prophylactic interventions

• bedridden pts

• decreased mobility 

• surgery

• paralysis

who is most at risk for DVTs

blood flow, venous stasis

the purpose of IPC is to increase ____ while also decreasing _____ and therefore decreasing the opportunity for clots to form 

venous insufficiency 

_______ is when abnormal valves in venous and lymphatic vessels cannot close and prevent backflow of blood 

• what do we do to help with this?……ankle pumps

incompetence

Venous statis ulcers are caused by valve ____ and/or obstruction of a vein = Venous HTN

• prolonged immobility

• obesity

• calf mms pump dysfunction

• pregnancy

Risks of Venous Stasis Ulcers are: (4)

venous circulation, rate

using compression for venous statis ulcers can improve ________ and ____ of healing

False

T/F: for venous statis ulcers, single layer compression is better than multilayered compression

CORNERSTONE

Compression therapy is the _______ of venous ulcer tx

Static Compression

________can also be used for limb shaping after amputation or preparing a limb for prosthetic

static compression, collagenase

Hypertrophic Scarring uses ______ compression to help with reducing scar formation by increasing ______ activity AND helps to decrease contractures

20-30 mmHg, 23 hrs/day

Recommended compression for hypertrophic scarring =

Contraindications

_______ for IPC include:

• Arterial insufficiency 

• uncontrolled HTN

• DVT or PE

• Obstructed venous return 

• CHF

• acute pulmonary edema

• malignancy 

• acute trauma/fx

• arterial revascularization 

Precautions

______ for IPC include:

• recent skin graft

• acute local dermatologic infection

• impaired sensation 

• impaired mentation

contraindicated

ABI < 0.06 =

reduced compression 23-27 mmHg

ABI 0.06-0.80 =

full compression 3-40 mmHg

ABI >0.8 =

• increased edema

• impaired circulation

• ischemia

• peripheral nerve injury

• increased cardiac load

Potential adverse effects of IPC are:

Sequential intermittent compression 

_______ is thought to provide more effective “milking” than single chamber compression sleeves 

Static Compression

______ involves bandages applied at resting or working pressures with various degrees of extensibility and applied in single or multi layers

• long stretch, short stretch, multilayered, semi-rigid

elastic

Resting pressure is exerted by ____ when it is put on stretch

inelastic

Working pressure is produced by active mms pushing against ______ bandages

RESTING PRESSURE

For _______ use high stretch bandages

• can extend 100-200%

• exerts 60-70 mmHg

• most effective on IMMOBILE pts

• ex: tubigrip, ace wraps

WORKING PRESSURE

For _______ use low stretch bandages

• little elasticity

• do NOT work in flaccid of inactive limbs

• ex: durelast

Thromboembolic Deterrents

________ (TED) or stockings/garments are off the shelf or custom-made and provide moderate resting AND working pressure

• wear 24 hr/day

• graded pressure (upper thigh - 8 mmHg) // (ankle - 18 mmHg)