Intermittent Pneumatic

Compression

Intermittent Pneumatic Compression➔Used primarily for the management of chronic edema➔Application of external mechanical pressure to alleviate the effects of edema. ➔Edema is reduced by moving excess interstitial fluid to sites of normal lymphatic or venous drainage

Definition of Terms

➔ Edema ➔ a condition in which the amount of fluid within

interstitial spaces is greater than normal➔ Effusion

➔ specifically refers to an excess of fluid in a cavity

➔ Ascites ➔ accumulation of fluid in the abdominal cavity

➔ Anasarca ➔ generalized massive edema

Physiologic Factors

Total Body Fluid

Intracellular Fluid

Extracellular Fluid

Plasma Interstitial Fluid

Free form Gel form

Physiologic Factors

Tissue compartments The intravascular compartment

contains fluid (i.e., blood) within the cardiac chambers and vascular system of the body

The extravascular system is everything outside of the intravascular compartment

cellular, interstitial, and lymphatic subcompartments

Physiologic Factors

Filtration is the movement of fluid out of the capillary

Reabsorption is the movement of fluid back into the distal

end of the capillary & small venules

Lymphatic system

removes excess fluid from the interstitium and returns it back to the intravascular compartment

Edema is developed when net capillary filtration exceeds the capacity of the lymphatics to carry away the fluid (i.e., net filtration > lymph flow)

Factors Regulating Exchange of fluid

1. Hydrostatic Pressuren Causes fluids moving through a semipermeable

membrane to flow from higher pressure to the lower pressure

2. Interstitial Pressure

n Normally negative (-5.3 mmHg); acts as a suction

Factors Regulating Exchange of fluid

3. Osmotic Pressuren Causes fluids to pass from areas of lower

concentration to areas of higher concentration of an osmotic substances

n Protein and sodium ionsn Oncotic Pressure (OP) or Colloid Osmotic

Pressure (COP)n (PCOP) / IFCOP

Factors Regulating Exchange of fluid

4. Vascular permeability (leakiness)

Permeability of the capillary wall is controlled by endothelial cells lining the blood vessels

Vasoactive substances (histamine)cause gaps between endothelial cells to increase

Factors that disrupt normal fluid exchange 

Changes in:• capillary permeability• release of vasoactive substances• increase of excessive decrease in tissue temperature• capillary hydrostatic pressure• increase arterial flow to capillaries• pooling of blood in veins: pressure on veins

Factors that disrupt normal fluid exchange 

Injury to tissue more fluid flows to the interstitium e.g. burns

Obstruction in the lymphatic system removal of lymph nodes (eg. Radical

mastectomy) elephantiasis

Effects of Edema

may cause pain due to increased pressure on the sensory nerve

may cause tissue necrosis due to lack of blood flow to a part resulting from the compression

decrease the range of motion and function of joints

osteoporosis of bone due to the lack of use

thrombosis and pulmonary embolism

Factors to Consider in Edemaacute or chronic

acute: swelling that has occurred recently and rapidly usually after an injury

chronic: swelling that persists for some time; related to a trauma or injury that remains beyond the time expected for normal healing to occur

amount of swelling accumulation of fluid in the interstitium

may be noticeable if it increase to 30% above normal

Factors to Consider in Edemaconsistency of the fluid

transudate vs. exudates pitting or non-pitting

site and size of edematous area near a nerve plexus or a major blood

vessel; pressure can block nerve conduction or blood flow and lead to further compliance

Indications

✔Chronic edema✔Lymphedema✔Amputation✔Prevention of thrombophlebitis✔Wound healing✔Venous stasis ulcers

Contraindications

✗Acute pulmonary edema✗Congestive heart failure✗Recent or acute DVT✗Acute fracture✗Acute local dermatological infections✗Edema immediately after a traumatic injury✗Arterial insufficiency✗Infection (at the site of treatment)✗Kidney dysfunction✗Obstructed lymphatic channels

IPC Units

air pumps

applied pressure to the limbs increase the pressure of the fluids in the interstitial spaces to a level higher than that of the lymph and blood vessels

IPC Units

the resulting pressure gradient encourages the fluids in the interstitial spaces to return to the venous and lymphatic vessels

since applied intermittently; acts like a pump

Modified IPC Units

Wright Linear Pump Compression through

different “cell” in the garment that gives more pressure distally than proximally

Gradient pressure promotes the flow of fluid from the distal to the proximal part of the limb

Modified IPC Units

Huntleigh Sequential System

Has 3 chambers, filled sequentially

Modified IPC Units

Jobst Cryo/ Temp Combination of ice

and compression Cooling of a limb

with either intermittent or continuous controlled compression

General Treatment GuidelinesKnow the indications and precautions of using the IPC unit

Have the knowledge and the skill on how to operate the unit

General Treatment Guidelineshave prior knowledge on the disease entity causing the edema that could be managed by using the unit

know the patient’s diagnosis, history and systemic or CV conditions

General Treatment Guidelinesrule out the presence of DVT by performing test or by observing the limb

explain to the patient the purpose of the IPC, how the treatment goes and what the patient should expect while undergoing treatment

Parameters

Know the range of physiologic pressure that could be applied to the limb involved

UE: 40-60 mmHg LE: 60-80 mmHg Pressure applied should not exceed the diastolic

pressure

Parameters

Inflation and deflation (3:1) Edema reduction: 45-90 sec on / 15-30 sec off

Shape residual limb: 4:1 ratio

Parameters

Treatment Duration Most out-patient settings

20 minutes Min daily for lymphedema

2 hours to 2-three hour sessions Traumatic edema

2 hours Venous ulcers

2.5 hours/3x/week to two hour periods Residual limb reduction

1 hour to 3 hour sessions totaling 4 hours

Techniques of Application

Before treatment Assess the involved limb Redness, warmth and other skin conditions Measure limb girth (us bony prominences as

reference points and mark the skin every 2-3 inches and record girth at each marking)

check for contraindications

Techniques of Application

Observe proper draping and positioning of patient

patient should wear comfortable and non-restrictive clothing

remove jewelry patient should be lying in supine comfortably;

breathing not compromised part to be treated should be encased in either

stockinette/pillowcase for hygiene part should be elevated to above the heart level

Techniques of Application

always check the patient’s BP and pulse to determine the amount of pressure to be applied using the diastolic pressure as basis

determine the settings of the unit as to inflation-deflation pressure, on-off time (3:1 ratio; 90 sec on, 30 sec off) and treatment duration

Techniques of Application

explain to the patient that the initial cycles may be uncomfortable but will subside as the treatment progresses

Should feel NO PAIN, TINGLING OR NUMBNESS from the pressure of IPC

allow at least 3 inflation-deflation cycles to check for any adverse reactions from the patient and any malfunctioning from the machine before leaving

Techniques of Application

After Treatment Return the unit’s settings to zero and

deflate the sleeves Check the patient’s BP Reassess the limb (take girth

measurements again) and skin condition

Techniques of Application

After Treatment Instruct patient to: Note return of edema (time, location, amount) Elevate the extremity as much as possible Apply compressive wrap or garment Engage in active movement as much as

possible

Techniques of Application

Welts may appear; explain to the pt. that these would disappear after 20-30 min.

Apply a compression bandage

Do after-care to the unit & the treatment area

Possible complications of treatmentSwelling in other areas

Controlled with elevation & gentle active exercise

Stiffness of joints with in treatment areaShortness of breath may indicate fluid overload in the lungs or pulmonary embolismNumbness or tingling in distal extremity

May indicate DVT, nerve irritation or damage

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Intermittent Pneumatic

Compression