03 Compression

what is compression?

inward directed mechanical force that increases pressure on the body

what are the primary clinical applications to compression?

prevent DVT

facilitate healing of venous ulcers

residual limb shaping

scar control

control of peripheral edema

what are 3 major pathways for fluid in the body?

1. circulatory system

2. lymphatic system

3. interstitial space between cells

what are indications for IPC (intermittent pneumatic compression)?

edema

prevention of DVT

venous stasis ulcers

lymphedema

what is normal lymphatic drainage?

fluid leaks into interstitial space, but is reabsorbed in venous or lymph system

what is abnormal lymphatic drainage?

an imbalance in fluid in interstitial space and reabsorption into venous/lymph system. can be caused by:

venous/lymphatic obstruction or insufficiency

increased capillary permeability

immobility

pregnancy

increased plasma volume

trauma, surgery, burns, infection due to increased blood flow

inflammatory process

T/F you can treat systemic diseases with compression

no!!

edema can lead to..

delayed healing

decreased ROM

decreased function

pain

skin pigment/collagen changes

contractures/deformities

ulceration

cellulitis

increased risk of infection

how to measure edema?

1. anthropometric measurements- must be taken at reproduceable landmarks

2. volumeter - water displacement

3. pitting edema

pitting edema scale: 1+ means:

barely detectable impression when finger is pressed into skin

pitting edema scale: 2+

slight indentation, 15 sec to rebound

pitting edema scale: 3+

deeper indentation, 30 sec to rebound

pitting edema scale: 4+

>30 sec to rebound

what compression to use for edema?

static wraps or intermittent pneumatic compression (IPC)

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

80

how does IPC prevent DVT?

increases blood flow, decreases venous stasis → decreased opportunity for clot to form

what is venous insufficiency?

valves in venous system are unable to close resulting in backflow of blood

what is the best way to return venous/lymph fluids?

physical activity with muscular contraction is best pump

what are venous stasis ulcers?

valve incompetence and/or obstruction of vein = venous HTN → increased pressure, inflammation, open wounds

what are risks of getting venous stasis ulcers?

prolonged immobility

obesity

calf muscle pump dysfunction

pregnancy

how can compression help venous stasis ulcers?

improve venous circulation

improve rate of healing venous stasis ulcers

_____ compression is more effective than single layer

_____ compression recommended for venous stasis ulcers

multilayered

mod-high

what is the cornerstone for venous ulcer treatment?

compression therapy

what can static compression be used for?

limb shaping - after amputation, residual limb reduction/shaping, prepare limb for prosthetic

hypertrophic scarring - increases collagen activity and decreases contractures

how long to wear static compression for hypertrophic scarring and how much pressure?

23 hrs/day

20-30 mmHg

what are contraindications for compression

DO NOT TX SYSTEMIC DISEASES w/COMPRESSION!

arterial insufficiency (ABI <0.06)

uncontrolled HTN

thrombosis (DVT or PE)

obstructed venous return

CHF

acute pulmonary edema

malignancy

acute trauma/fracture

arterial revascularization

what are precautions to IPC

recent skin graft

acute local dermatological infections

impaired sensation

impaired mentation

ABI ____ = contraindicated

ABI ____ = reduced compression (23-27 mmHg)

ABI ____ = full compression (30-40mmHg)

ABI <0.06 = contraindicated

ABI 0.06-0.80 = reduced compression (23-27 mmHg)

ABI >0.80 = full compression (30-40mmHg)

what are potential adverse effects of IPC?

increased edema

impaired circulation

ischemia

peripheral nerve injury

increased cardiac load

IPC devices

sequential intermittent compression thought to provide more effective “milking” than single chamber compression sleeve

resting vs working pressure

for static compression, bandages apply resting or working pressure

resting pressure: exerted by elastic when it is put on stretch

working pressure: produced by active muscles pushing against inelastic bandages

when to use high stretch bandage?

resting pressure, most effective on immobile patients

ex: Tubigrip, Ace wraps

when to use low-stretch bandage?

working pressure due to little elasticity, do not work in flaccid or inactive limbs

ex: Durelast

thrombo-embolic stockings/garments

off the shelf or custom

provide moderate resting and working pressure

worn 24 hrs/day

graded pressure