Compression Management

Lymphedema
-slowly progressive, pitting (early)
-usually begins distally, hyperkeratosis
-pain rare
-frank ulceration unusual
DVT
-pain (although may be asymptomatic)
-local warmth/redness
other local causes of edema (usually unilateral)
-trauma
-ruptured synovial cyst
-hematoma
-rheumatiod arthritis
-soft tissue tumor
venous edema symptoms
-no pitting
-brawny
-brownish discoloration of skin
-fibrosis of subcutaneous tissue
-atrophic skin
-ulceration
-resolves w/recumbent position
infection/cellulitis signs/symptoms
-pain
-fever
-redness (blotchy)
medications that cause edema
-steroids
-Ca channel blockers
-pschotropic agents
-estrogens
-swelling that is usually bilateral and painless
reflex sympathetic dystrophy (RSD) or chronic regional pain syndrome (CRPS)
-pos-traumatic
-autonomic dysfunction
-burning pain
cardiac edema symptoms
-pitting
-complete resolution w/elevation
-greatest distally
-no pain
-always bilateral
-possible repiratory symptoms
other systemic causes of edema
-hepatic/renal failure
-hyperthyroidism
-allergic reaction
malignancy edema symptoms
-pain
-rapid onset
-proximal involvement
LaPlace’s law
pressure is directly related to tension and number of layers and is inversely related to the limb circumference
compression indications
-reduce edema
-venous insufficiency
-worn over many wound types/sizes w/appropriate prim./sec. dressings
limitations of compression
-arterial insufficiency
-DVT
-acute infection
-acute CHF
-error donning/doffing
-tunicate effect
-expensive
pneumatic compression pumps
-multi-compartmental
-sequantial (distal then prox)
-cycles on/off (3:1)
how long would you treat a patient with a pneumatic compression pump?
up to an hour
how high do you elevated the treatment extremity for pneumatic compression?
extremity that is treated must be elevated higher than the heart
what is an Unna Boot?
-an inelastic gauze impregnated w/ zinc oxide, gelatin, and glycerin
Where is an Unna boot usually applied and how long is it left on?
-below the knee to the foot (LL edema)
-7-10 days
what does an Unna boot do?
-improves calf pump function
-reduces ambulatory venous hypertension
-semirigid support
-delivering zinc to aid wound healing
short stretch bandages
-standard care for chronic venous insufficiency ulcers
-increased healing rate/reduced PAIN
long stretch bandage
-high working pressure
-high resting pressure
working pressure
-resistance presented by the bandage to the expansion of muscles during muscle contraction
what are examples of long stretch compression?
-fashion hoisery
-TED stockings
-ACE wraps
what is the mm Hg of long stretch compression wraps?
8-18 mmHg
what are examples of short stretch compression systems?
-Unna boot
-tubigrip
-comprilan
-Reid sleeve
what is a Reid sleeve?
-a custom-made tubular extremity device w/a nylon and velcro outer shell and a foam insert with a lycra lining
what is the compression level of short stretch systems?
-up to 24 mmHg
what is the compression level for multilayer wraps?
-up to 40 mm Hg
what are examples of multilayer wraps?
-profore bandages
-dynaflex
-surepress
-CircAid Compression Bandage Systems
CircAid Compression Bandage System
-removable/can be washed
-a legging
-Velcro fasteners that surround the leg
-bands adjusted as edema changes
what is the multilayer compression wrap made up of?
-long and short stretch systems
what is the compression level of a class I compression stocking?
20-30 mm Hg
what is the compression level of a class II compression stocking?
30-40 mm Hg
what is the compression level of a class III compression stocking?
40-50 mm Hg
what is the compression level of a class IV compression stocking?
60+ mm Hg
what are the signs and symptoms of critical limb ischcemia?
-persistent resting pain needing analgesia >2 weeks
-OR ulceration/gangrene of toes/foot w/ankle pressure
what is considered a normal ABI?
1.0
what is the first level of ABI that high pressure would be indicated?
-0.8-1.0 (>30mmHg)
what is the level of ABI that light compression would be indicated?
0.5-0.8 (<30mmHg)
what is an ABI that would be a contraindication for compression?
<0.5 ABI
what are advantages of edemawear?
-four-directional compression
-easier donning/doffing
-cooler/more comfortable
-low pressure gradient
-4/5 skin non-compressed
-effective for lymph/venous circulation
-used for very low ABI
how much lower does the pneumatic compression pump need to be than the diastolic presure in mmHg?
-20 mmHg below diastolic pressure
-for arterial insufficiency 40 mmHG or below diastolic