PT 412 Intermittent Compression Devices

edema

presence of abnormal amounts of fluid in the extracellular tissue spaces

joint swelling, joint effusion

blood and joint fluid accumulated immediately following injury within joint capsule

lymphedema

swelling in subcutaneous tissues results from excessive accumulation of lymph(overdistension of lymph capillaries) occurring over several hours following injury

joint effusion

A type of swelling that occurs inside a joint/joint capsule

true

True or False? Edema and swelling are the same thing

pitting edema

indentation left after examiner depresses the skin over swollen edematous tissue, common with lymphedema

lymphatic system

As plasma and plasma proteins escape from small blood vessels they are picked up by what system to be returned to blood circulation?

safety valve for fluid overload

Lymphatic system acts as what?

interstitial fluid

The lymph system can be overwhelmed by sudden local increases in:

lymphatic system

Closedvascularsystem of endothelial cell lined tubes that parallel arterial and nervous system

circulatory

lymph vessels parallel what other system?

Interstitial fluid

What surrounds lymphatic capillaries?

terminal lymphatics

provide the entry way via valves into the lymphatic system for the excess interstitial fluid and plasma proteins

proximal

Are lymph nodes and structures more prominent in proximal or distal segments?

lymphatic capillaries → network of lymphatic vessels → collecting vessels → vascular system

Flow of lymph from distal to proximal

fibrils

The lymphatic capillaries are made of singlelayered endothelial cells with _____________ radiating from the junctions of the endothelial cells

support lymphatic capillaries, anchor to connective tissue

function of lymphatic fibrils

True

As intercellular fluid accumulates, the fibrils radiating from the seams in the lymphatic capillary pull the seam open to create a pore large enough for plasma proteins to enter. True or False?

lymph

what are the interstitial fluid and proteins called once they enter lymphatic capillaries?

muscle activity, active/passive movement, elevated positions, respiration and blood vessel pulsation, compression

Activities that can aid in the movement of lymph

Wolff's Law

#1 benefit of ROM exercises involves what concept?

mobilizing lymph and edema

#2 benefit of ROM exercises involves what concept?

first aid, PRICE

What can you do immediately after an injury to minimize edema

cold, compression, elevation, negative HV E-Stim

retards accumulation of fluid and keeps lymphatic system functioning at an optimum level

decreased plasma protein content

With tx that encourage lymph flow, what happens in the intercellular spaces?

bloodstream

Where does lymph fluid carry waste products and destroyed bacteria back to?

liver, kidneys

Once back into the bloodstream, waste products and destroyed bacteria are removed via what structures?

bowel movements, urine

How does the body expel waste products and destroyed bacteria?

gravity

can be used to augment normal lymph flow by encouraging its movement

higher

The _________ the elevation, the greater the effect on the lymph flow

ace wrap, tubi-grip, cryocuff, compression stockings/sleeves

What could we pair with elevation ti further aid lymph mobility?

Rhythmic internal compression/muscle contraction

will squeeze/pump lymph through lymph vessels improving its flow back to the vascular system

Retrograde massage, elastic compression, intermittent pressure devices

most often used external pressure devices

Jobst garments, Gottfried

Pressure dressings commonly used (custom)

PTs

Who measures/fits pts for custom pressure dressings?

non-custom, tubi-grip

Non-custom compression garments

inflation pressure, on/off time, total tx time

Intermittent Compression Treatment Parameters

reduce blood clot risk

What is a pneumatic boot in hospital mainly used for?

blood pressure

Therapeutic pressure settings on Jobst pumps are loosely correlated with what?

diastolic

A pressure on Jobst pumps approximating ___________ blood pressure is the MAX pressure, which we should not exceed

30 mmHg

Arterial capillary pressures during rest

30 mmHg

Any pressure exceeding what value should encourage reabsorption of the edema and movement of lymph

30-60 mmHg

Tx range pressure for UE

40-70 mmHg

Tx range pressure for LE

40-50 mmHg

what pressure may be best used for both LE and UE?

50 sec on/off

common and optimal on/off time sequences on jobst pumps

30-60 min

Typical tx time with jobst pumps

AAROM

What should we instruct patients to do during compression tx OFF cycle?

patient comfort

Primary deciding factor during on on/off cycle for jobts pump

half leg/arm, full leg/arm

Variations of compression sleevs

rubber hose and valve

Deflated compression sleeve is connected to compression unit via what devices?

Sequential Compression Pumps

Incorporates sequentially inflated multiple
compartment designs

distal → proximal

With Sequential Compression Pumps, where does the pressure build first?

20 mmHg

pressure difference at each hose on a Sequential Compression Pump

DBP

What should the highest pressure, on the distal sleeve of a Sequential Compression Pump, be determined by?

30/50 sec on, 30/50 sec off

Sequential Compression Pumps tx on/off time

False ("Unlike ice, cannot really do Tx too long")

True or false? You should be concerned with using Sequential Compression Pumps for too long?

30-60 min

Typical tx time for Sequential Compression Pumps

skin integrity, patient tolerance

What should be inspected before/during tx with compression pumps?

cold + compression

has been shown to be clinically effective in treating many edema conditions

inhibition (NOT shrinking)

Effect of cold on edema

cryo-cuff, game ready system

devices which make use of a combination of cold and compression which provides an inexpensive means of treating edema

lymphedema, traumatic edema, chronic edema, stasis ulcers, wound healing

Indications for Intermittent Pneumatic Compression

compartment syndrome, PVD, DVT, blood clot, superficial infection, congestive heart failure, acute pulmonary edema, displaced fractures, do not exceed DBP

Contraindications for Intermittent Pneumatic Compression

Blood flow restriction

restrict arterial inflow while occluding venous return, typically used for muscle growth and recovery; NOT for edema