1. © 2005 – FA Davis, Inc. Compression Devices

2. © 2005 – FA Davis, Inc. Purposes Edema reduction –Improves healing environment –Reduces neuromuscular inhibition –Improves range of motion –Decreases pain Prevention of deep vein thrombosis –Increasing venous flow prevents clot formation

3. © 2005 – FA Davis, Inc. Types of Units Circumferential –Inflates as a unit Constant –Inflates and remains inflated Intermittent –Cycles off and on Sequential –Milks from distal to proximal –Chambers inflate individually Media –Air (pneumatic) –Chilled water (hydraulic) Sequential Compression [Instructor: Click to Start Animation]

4. © 2005 – FA Davis, Inc. Physiological Effects Mechanical pressure reduces edema Forces venous fluids proximally Decreases capillary filtration pressure, limiting formation of edema –Constant compression devices used in the acute setting –Efficacy relative to simple elevation has not been substantiated

5. © 2005 – FA Davis, Inc. Physiological Effects Increased lymphatic uptake Lymphatic system consists of “buds” Spreads exudate –Comes into contact with more buds Improved absorption and removal of solid wastes Lymphatic Buds

6. © 2005 – FA Davis, Inc. Physiological Effects Range of Motion –Reduced fluid from the joint Prevents arthrogentic muscle inhibition Decreased fluid improves joint motion –Decreases hydraulic pressure Pain –Decreased fluid decreases mechanical pain Decrease pressure on nerve endings –Improved vascular function decreases chemical pain Improved blood/oxygen supply

7. © 2005 – FA Davis, Inc. Contraindications Possibility of an unhealed fracture Compartment syndromes Current peripheral vascular disease Arteriosclerosis Edema secondary to congestive heart failure Ischemic vascular disease Gangrene Dermatitis Deep vein thrombosis Thrombophlebotis

8. © 2005 – FA Davis, Inc. Precautions The pressure applied should not exceed the diastolic blood pressure –Upper extremity: 40 to 60 mm Hg –Lower extremity: 60 to 100 mm Hg Too much pressure may result in ischemia Wrinkling of underlying Stockinette may result in high-pressure areas.

9. © 2005 – FA Davis, Inc. Clinical Application of Intermittent Compression

10. © 2005 – FA Davis, Inc. Instrumentation Power: Turns the unit on or off. Temperature: Adjusts the temperature of the fluid. Pressure: Adjusts the amount of compression in millimeters of mercury (mm Hg) applied to the extremity. –This value should not exceed the patient’s diastolic blood pressure. On-off time: Controls the proportion of the time that the compression is on and off. Pump: Turns on the pressure to the appliance. Drain: Removes the pressure and deflates the appliance.

11. © 2005 – FA Davis, Inc. Preparation of the Treatment Establish the absence of contraindications. Remove any jewelry on the extremity being treated. Determine the patient’s diastolic blood pressure. Note the girth measurement of the body part being treated. Cover the area to be treated with Stockinette™ or similar material. –Care must be taken to ensure that this inner layer is free of wrinkles. Select the appropriate appliance for the extremity being treated. Insert the injured limb into the appliance. –When full-length appliances are used, avoid bunching the garment in the axilla or groin. For best results, elevate the limb during treatment. –Inflate fluid-filled units before elevating the body part. Connect the appliance to the compression unit.

12. © 2005 – FA Davis, Inc. Initiation of the Treatment If applicable, set the TEMPERATURE to be used, generally between 50° and 55°F. Select the maximal PRESSURE for the treatment. Normal pressure ranges: –40 to 60 mm Hg for the upper extremity –60 to 100 mm Hg for the lower extremity Select the ON-OFF times. –A 3:1 duty cycle (e.g., 45 seconds ON, 15 seconds OFF) is often used –Effects of these ratios has not been substantiated Select the appropriate TREATMENT TIME. –Post-traumatic edema: 20 to 30 minutes. –Lymphedema: several hours. Inform the individual about the sensations to be expected during the treatment. Instruct the patient to perform gentle range-of-motion (ROM) exercises during the off cycle, if appropriate: –Wiggle the fingers (upper extremity treatments) or toes (lower extremity treatments). If long-term treatments (i.e., more than 60 consecutive minutes) are being administered, regularly interrupt the session and inspect the extremity being treated for proper capillary refill and sensation or the presence of unusual marking or unexpected pitting edema.

13. © 2005 – FA Davis, Inc. Alternate Applications Elevate the extremity –Gravity assists in venous/lymphatic return Electrical Stimulation –Motor-level stimulation provides muscle pump

14. © 2005 – FA Davis, Inc. Termination of the Treatment Reduce the ON time or select the DRAIN mode to remove the air or fluid from the appliance. Allow the appliance to deflate Gently remove the body part from the appliance. Remeasure the circumference of the extremity and determine the amount of edema reduction. Apply a compression wrap and any appropriate supportive devices. Encourage the patient to keep the limb elevated whenever possible between treatments.

15. © 2005 – FA Davis, Inc. Typical Maintenance Disconnect the compression unit from the electrical power source prior to cleaning. FOLLOWING EACH TREATMENT Check the appliance for tears or leaks. If a defect is found: –Repair the defect with an approved patch kit –Return the appliance to the manufacturer for repair –Or discard the appliance. Clean the appliance using an approved cleanser. If appliances are machine washable, turn them inside out and close them. Some appliances can be sterilized using gas systems. QUARTERLY OR AS INDICATED Check air/water hoses for defects and replace if necessary. Clean the external unit using an approved cleanser. Check the plugs, cables, and cords for knicks, frays, or other visible damage. ANNUALLY OR AS REQUIRED A qualified service technician should perform an inspection and calibration and perform any needed maintenance.