3.3 - compression

inward

compression is a ____________ directed mechanical force that increases pressure on the body

• prevent DVT

• facilitate healing of venous ulcers 

• residual limb shaping 

• scar control

• control of peripheral edema 

primary clinical applications for compression (5) 

• circulatory system

• lymphatic system

• interstitial spaces between cells

what are the 3 major pathways that fluid travels through

hydrostatic; osmotic

fluid exchange at the capillary occurs via _________ and ________ pressures

90;10

about ______% of fluid travels through arterial and venous pathways and about ______% of fluid travels through the lymph system

• edema 

• prevention of DVT

• venous statis ulcers 

• lymphedema 

indications for Intermittent pneumatic compression (4) 

true (ex. congestive heart failure and cirrhosis)

T/F: we do not treat systemic diseases with compression

venous

hemosiderin staining is a result of _________ insufficiency

• anthropometric measurement (taken at reproducible landmarks) 

• volumeter (water displacement) 

• pitting edema 

3 ways to measure edema 

1+

where does this fall on the pitting edema scale:

barely detectable impression when finger is pressed into skin

2+

where does this fall on the pitting edema scale:

slight indentation, 15 sec to rebound

3+ 

where does this fall on the pitting edema scale:

deeper indentation, 30 sec to rebound 

4+

where does this fall on the pitting edema scale:

more than 30 seconds to rebound

15

a grade 2+ pitting edema takes ________ seconds to rebound

30

a grade 3+ pitting edema takes ________ seconds to rebound

>30 

a grade 4+ pitting edema takes ________ seconds to rebound

osmotic

the theory of compression for edema is applying compression to change pressure and have an external force to increase ________ pressure so fluid return into venous/lymph systems

80

_____% of patients undergoing orthopedic sx will develop VTE without prophylactic interventions

bed ridden/not moving 

who is most at risk for getting a DVT 

inc; dec; dec

intermittent pneumatic compression:

• (dec or inc) blood flow

• (dec or inc) venous statis

• (dec or inc) opportunity for clot to form

physical activity with muscular contractions

what method is the best to return venous/lymph fluid

venous 

compression is recommended with venous or arterial ulcers

• prolonged immobility 

• obesity 

• calf muscle pump dysfunction 

• pregnancy 

what are the 4 risks of developing venous stasis ulcers 

true

T/F: compression can improve the rate of healing venous statis ulcers

false (multilayer is better)

T/F: multilayered compression has the same effect as a single layer for treating venous statis ulcers

mod-high (40-60mmHg)

what level of compression is recommended to treat venous statis ulcers?

• used after amputation 

• residual limb reduction and shaping

• prepare limb for prosthetic 

what circumstances is compression used for limb shaping 

collagenase

compression can reduce scar formation by increased ________ activity

20-30mmHg; 23 hours a day

what is the recommended compression intensity and duration for hypertrophic scar treatment

true (limits ROM and function tho) 

T/F:  compression can treat hypertrophic scars by decreasing contractures 

• <0.06

• 0.06-0.80

• >0.80

contraindications for compression with arterial insufficiency:

• ABI ______ = contraindicated

• ABI ______ = reduced compression 23-27mmHg

• ABI ______ = full compression 30-40mmHg

• Arterial insufficiency

  • ABI <.06 = Contraindicated

  • ABI .06-0.80 = reduced compression 23-27 mmHg

  • ABI >0.80 = full compression 30-40 mmHh

• Uncontrolled HTN

• Thrombosis: DVT or PE

• Obstructed venous return

• CHF

• Acute pulmonary edema

• Malignancy

• Acute trauma/Fracture

• Arterial revascularization

contraindications for intermittent pneumatic compression

• Recent skin graft

• Acute local dermatologic infections

• Impaired sensation

• Impaired mentation

precautions for intermittent pneumatic compression

• increased edema

• impaired circulation

• ischemia

• peripheral nerve injury

• increased cardiac load

potential adverse effects of compression (5)

milking

sequential intermittent compression is thought to provide more effective “_________” than single chamber compression sleeves

sequential = goes in sequence 

uniform = all at once 

what is the difference between sequential and uniform compression 

resting; working

bandages apply _________ or ___________ pressure

resting

resting or working bandage pressure:

exerted by elastic when it is put on stretch

working 

resting or working bandage pressure:

produced by active muscles pushing against inelastic bandages

mobility

working pressure bandages only work if the patient has some ___________

• Long stretch

• short stretch

• multilayered

• semi-rigid

what are the types of bandages used for compression

resting 

resting or working bandage pressure:

use high-stretch bandages 

working

resting or working bandage pressure:

use low-stretch bandages

resting

resting or working bandage pressure:

most effective on immobile patients

resting 

resting or working bandage pressure:

examples:  tubigrip, ace wrap 

working

resting or working bandage pressure:

example: durelast

resting

resting or working bandage pressure:

provides greatest resting pressure

working 

resting or working bandage pressure:

provides high working pressure 

working

resting or working bandage pressure:

little elasticity

both

thrombo-embolic stockings/garmets provide moderate (resting or working) pressure

24 hours per day

what is the duration recommendation for wearing thrombo-embolic stockings/garmets