VITAL SIGNS AND INTERMITTENT COMPRESSION DEVICES/PUMP

PHT 1251C - Day 1

Preparation for Patient Care

• Preparing clear patient care environment/ room

• Preparation of the treatment area for the next patient at the end of each patient treatment

• Risk Management• Maintenance of the treatment area• Prior to patient treatment

Vital Signs

• Heart Rate• Blood Pressure• Respiration• Temperature

Heart Rate

• Pulse = beats per minute (bpm)• Basal Heart Rate • Resting heart rate • During physical activities • After physical activities • Patency

Methods

• Manual Palpation• HR measuring sites– Radial pulse palpation– Carotid pulse– Auscultation – page 121

• Brachial artery• Femoral artery• Popliteal artery• Posterior tibial artery• Dorsal pedal pulse

HR ranges

• Normal Adult:• Normal infant/child:• Bradycardia:• Tachycardia:

Blood Pressure (BP)

• Measures of vascular resistance to blood flow• Systolic pressure • Diastolic pressure • Measurement unit

Methods

• Equipment:• Most common location:• Positioning:• Type of equipment used:• Documentation:

BP Ranges

• Ideal BP = 120/80 mmHg• Normal BP • Pre-hypertension • Stage 1 hypertension (HTN) • Stage 2 hypertension (HTN)

Respiratory Rate (RR)

• Respiratory Rate

• Method

• Norms

Temperature

• Purpose:

• Sites:

• Range:

Intermittent Compression

• Edema – definition

• Joint Swelling – definition

• Lymphedema – definition

Lymphatic systems

• The fluid in the interstitial spaces in continuously circulating

• The lymphatic system acts as a safety valve for fluid overload and helps keep edema from forming

• The homeostasis of the extracellular environment is maintained by the lymphatic system

• The lymphatic system also cleanses the interstitial fluid and provides a blockade to the spread of infection or malignant cells in the lymph nodes

Intermittent Compression Treatment Techniques

• Inflation pressure

• On-off time sequence

• Total treatment time

Intermittent Compression Treatment Techniques

• Inflation pressure – Ranges: UE – 30 to 60 mmHg; LE – 40 to 80

mmHg• On-off time sequence

• Total treatment time

Inflation pressure • Common intermittent Compression Treatment Protocol• Attach sleeve to compression pump via tubing• Turn pump on and inflate to < 60 mm for LE and <50 mm for UE • Caution: do not exceed diastolic blood pressure.• Adjust the compression pump to cycle in a 3:1 ratio of on and off time • Set duration of treatment from 30 minutes to 1 hour ( in some cases

patient may tolerate up to 2-3 hrs)• Encourage the patient to wiggle his or her fingers or toes during the

off cycle.• Remove the sleeve at least once during the course of treatment to

inspect skin and allow joint motion.

On-off time sequence

• There is a big variety of timing used out there, however patient comfort should be the first thing to be considered. The ranges might be:

• 30s on, 30s off• 1 min on and 2 min off• 2 min on and 1 min off• 4 min on and 1 min off.

Total treatment time • lack of research to support the appropriate time of treatment. As

always the rule number one is to ensure patient comfort during the treatment. Most protocols for lymphedema call for 3-4 hrs treatment daily (accumulative), however, for the more aggressive treatment based on patient tolerance, 8 hrs may be appropriate considering patient’s medical conditions to tolerate the treatment with physicians’ order and approval.

• Some research reported that is a marked increase in lymph flow on the initial ICP

• Lymph flow decreases on the initial 10 minutes after discontinue using the ICP and then stops after that.

• Clinical studies show significant gains in the limb volume reduction after 30 minutes of compression.

Sequential Compression Pumps• Multiple compartment design with sequential inflation• May include a programmable gradient design• Massage effect from distal to proximal pressure with gradual decrease

in the pressure gradient• The highest pressure is located distally• The middle compartment (chamber) of the sleeve is set 20 mmHg

lower pressure than the distal chambers of the compression sleeve• The proximal compartments are 20 mmHg lower pressure than medial

chambers.• Some of the LE compression sleeves has 6 sequential compartments• Pressurization initiates always from the most distal chambers in

direction to the most proximal chamber. • It takes 2 minutes to fill all the chambers• It may be used in combination with electrical stimulation to promote

muscle contraction.

Patient Setup and Instructions• Patient should have the appropriate sized compression appliance fitted on

the extremity in an elevated position.• Compression sleeves comes as (single or sequential compartment sleeves)

– Foot-ankle– Half-leg– Full-leg– Full-arm– Half-arm

• Connect the deflated compression sleeves to the compression unity via a flexible hose and connecting valve.

• Once the machine is on, adjust 3 parameters– On-off time,– Inflation pressure– Treatment time

• When the unit cycle is off, the patient should be instructed to move the extremities. (30s on and 30s off is recommended for patient comfort and effectiveness in most cases).

Indications and Contraindications• Indications

– Lymphedema– Traumatic edema– Chronic edema– Stasis ulcers– Intermittent claudication– Wound healing following surgery

• • Contraindications

– Deep vein thrombosis– Local superficial infection– Congestive heart failure– Acute pulmonary edema– Displaced fractures

Compression Garment (1)

• Advantages:– The patient can wear for the whole day and take

off only for shower– Easy to care for– New versions may have modifications to put it on

such as zipper on the back of the leg of the stockings

– You can wear it and move around.

Compression Garment (2)

• Disadvantages:– The original stockings are not always easy to don– It must be worn all the time (lymphedema)– It can be costly, since most of the medical

insurances do not pay for them.

Case study 1• This is Tom who was

diagnosed with lymphedema to his LLE.

• Take his Vital Signs• Setup his intermittent

compression pump using all the 3 parameters

QUESTIONS?