Intermittent Compression Devices Jennifer Doherty-Restrepo, ATC, LAT Entry-Level Athletic Training...
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Transcript of Intermittent Compression Devices Jennifer Doherty-Restrepo, ATC, LAT Entry-Level Athletic Training...
Intermittent Intermittent CompressionCompressionDevicesDevices
Jennifer Doherty-Restrepo, ATC, LAT
Entry-Level Athletic Training Education Program
PET 4995: Therapeutic Modalities
DefinitionsDefinitions
Edema Abnormal amounts of fluid in extracellular
tissue spaces Joint swelling
Blood and/or fluid accumulation Appears and feels like a water balloon
Lymphedema Accumulation of lymph in subcutaneous tissues Occurs over several hours following injury
The Lymphatic SystemThe Lymphatic System
Pick up plasma and plasma proteins that escape from small blood vessels and return them to blood circulation
Acts as a safety valve for fluid overload Prevents edema formation
Maintains homeostasis of extracellular environment Removes excess protein molecules and waste
from the interstitial fluid Cleanses interstitial fluid
Blocks thes spread of infection or malignant cells
The Lymphatic SystemThe Lymphatic System
Closed vascular system
Parallels arterial system
Lymphatic capillaries made of single layered endothelial cells
The Lymphatic SystemThe Lymphatic System
Lymphatic capillaries are surrounded by interstitial fluid
Terminal lymphatics provide entry way into lymphatic system for excess interstitial fluid and plasma proteins
The Lymphatic SystemThe Lymphatic System
Lymphatic capillaries form a network of lymphatic vessels
Lead to larger Collecting Vessels in extremities
Collecting vessels connect with thoracic duct or right lymphatic duct, which join the venous system
The Lymphatic SystemThe Lymphatic System
Fluid moving into interstitial spaces pushes or pulls on fibrils Fibrils = connective tissue fibers supporting lymphatic
capillaries Endothelial cell junctions in lymphatic capillary wall
open Allows entry of interstitial fluid,
cellular waste, large protein molecules, plasma proteins, extracellular particles, and cells into terminal lymphatics
The Lymphatic SystemThe Lymphatic System
Once in the terminal lymphatics, the interstitial fluid, cellular waste, large protein molecules, plasma proteins, extracellular particles, and cells become lymph
Endothelial cell junctions in lymphatic capillaries remain closed when there is … No increase in interstitial volume No tissue activity
Movement of lymph is accomplished via muscle activity, active and passive motion, elevation, respiration, and blood vessel contraction
Injury Edema: Injury Edema: Pitting EdemaPitting Edema
Local edema Formed by plasma, plasma proteins,
and cellular debris moving into interstitial spaces
Hormones released by injured cells stimulate small anterioles, capillaries and venules to vasodialate separating endothelial cells in vessel wall Increases permeability
Injury Edema: Injury Edema: Pitting EdemaPitting Edema
Increased permeability allows more plasma, plasma proteins, and cellular debris to escape into local area
Results in gel-like fluid that is trapped by collagen fibers
Gel-like fluid referred to as pitting edema
Injury Edema: Injury Edema: LymphedemaLymphedema
Accumulation of edema causing overdistention of lymph capillariesEntry pores become ineffective and
interstitial fluid increases Lymphedema results Constriction of lymph capillaries due
to increased pressure will also discourage lymph flow and cause lymphedema formation
Negative Effects of EdemaNegative Effects of Edema
Edema compounds injury by causing secondary hypoxic cellular death in surrounding tissues
Other negative effects include: Physical separation of torn tissue ends Pain Restricted joint range of motion Prolonged recovery times Interstitial fibrosis Reflex sympathetic dystrophy
Treatment of EdemaTreatment of Edema
P.R.I.C.E. Minimize edema
formation E-stim or AROM
exercises Retard edema
accumulation Any treatment that assists lymph flow
will decrease plasma protein content in interstitial spaces and decrease edema
Treatment of Edema: Treatment of Edema: ElevationElevation
Gravity used to assist lymph flow
The higher the elevation, the greater the effect on the lymph flow
Treatment of Edema: Treatment of Edema: CompressionCompression
Muscle contractions provide rhythmic internal compression of lymph vessels to assist lymph flow Isometrics, AROM exercise, or E-stim
External compression assists lymph flow Massage, elastic compression, or intermittent
pressure devices External compression spread interstitial
edema over a larger area, enabling more lymph capillaries to become involved in removing plasma proteins
Treatment of Edema: Treatment of Edema: WeightWeight-Bearing ExerciseBearing Exercise
Activates a venous pump Not related to muscle activity
Mediated by release of an endothelial-derived relaxing factor (EDRF)EDRF is liberated by sudden pressure
changes and it diffuses locallyFunctions to relax smooth muscle and
stimulate blood flow in the veins
Treatment of Edema: Treatment of Edema: CryotherapyCryotherapy
Cryotherapy used in conjunction with intermittent compression has shown the best results in the reduction of post-acute injury edema
Intermittent Compression Intermittent Compression Treatment ParametersTreatment Parameters
Inflation Pressure On/Off Time Sequence Total Treatment Time
Inflation PressureInflation Pressure
Loosely correlated with BP
Most treatment protocols utilize a pressure approximating diastolic BP
Inflation PressureInflation Pressure
Arterial capillary pressures ~ 30 mmHg
Any pressure that exceeds this should encourage Edema absorption,
and Lymph flow
Inflation PressureInflation Pressure
Maximum pressure should correspond to diastolic BP
More pressure is not necessarily better
Enough pressure is needed to squeeze lymphatic vessels and encourage lymph flow
On/Off Time SequenceOn/Off Time Sequence
On/Off time sequences are variable
Patient comfort should be a primary deciding factor
30s on, 30s off is effective and comfortable
Lymphatic massage Shorter on/off time
sequences may have an advantage
Total Treatment TimeTotal Treatment Time
Clinical studies show significant limb volume reduction after 30 minutes of compression
A treatment of 10 - 30 minutes may be adequate unless edema is overwhelming in volume or is resistant to treatment
Multiple treatment times per day may also be an advantage in controlling and reducing edema
Equipment Setup and InstructionsEquipment Setup and Instructions
Compression sleeves Half-leg, full-leg,
half-arm, or full-arm Connect
compression sleeve (deflated) to unit via a rubber hose and connecting valve
Equipment Setup and Instructions
Assess BP and set inflation pressure Set On-time (between 30 to 120 seconds) Off-time is left at 0 until the compression
sleeve is inflated and treatment pressure is reached Then adjust off-time between 0 and 120 seconds
During the off-time, instruct patient to move extremity
Treatment should last between 20 - 30 minutes
Cold and Compression Cold and Compression CombinationCombination
Combination of cold and compression is effective in treating edema
Cold/compression unit
Temperature adjustment ranges between 10 - 25oC
Cooling accomplished by circulating cold water through compression sleeve
Compression and Electrical Compression and Electrical Stimulating CurrentsStimulating Currents
Combination of compression and e-stim induced muscle pumping is effective in treating edema
Facilitates reabsorption of injury byproducts by lymphatic system
Sequential Compression PumpsSequential Compression Pumps
Sequentially inflate compression sleeves with multiple compartments
Massage effect Applies pressure
from distal to proximal
Gradual decrease in pressure gradient
Sequential Compression PumpsSequential Compression Pumps
Highest pressure in distal compartment sleeve Determined by mean value
of systolic to diastolic BP
Middle compartment is set at 20 mm lower than the distal cell
Proximal compartment pressure is reduced an additional 20 mm
Sequential Compression PumpsSequential Compression Pumps
Each pressure cycle is 120s
Distal compartment is pressurized initially and continues pressurization for 90s
20s later, the middle compartment inflates
After another 20s, the proximal compartment inflates
A final 30s period allows pressure in all three compartments to return to 0
Entire cycle is then repeated
IndicationsIndications
Lymphedema Traumatic edema Chronic edema Stasis ulcers Intermittent claudications Postoperatively to reduce the possibility
of developing a deep vein thrombosis Facilitate wound healing following
surgery
ContraindicationsContraindications
Deep vein thrombosis Local superficial infection Congestive heart failure Acute pulmonary edema Displaced fractures Cancer