Week 9 Compression

Question 1

what is compression?

Answer 1

a mechanical force that increases external pressure on the body or a body part

Question 2

what is compression used for?

Answer 2

to improve fluid imbalance and circulation or modify scar tissue formation

Question 3

what are the two type of compression?

Answer 3

static: constant force like compression garment
intermittent: varying force over time

Question 4

what are the effect of external compression?

Answer 4

-improves venous and lymphatic circulation
-limits the shape and size of tissue
-increases tissue temperature
-edema reduction (improves healing environment, reduces neuromuscular inhibition, improves ROM, and decreases pain)
-prevention of DVT (increases flow in venous system to prevent clotting)

Question 5

how does compression improve venous and lymphatic circulation?

Answer 5

-increases external hydrostatic pressure
-intermittent compression may be more effective than static by milking fluids from proximal to distal vessels

Question 6

when is compression used to limit shape and size of tissue?

Answer 6

after amputation or burns

Question 7

how does compression increase tissue temperature?

Answer 7

may increase activity of temperature-sensitive collagenases to control scar formation

Question 8

what are the clinical indications for the use of external compression?

Answer 8

-EDEMA CONTROL
-prevention of DVT
-venous stasis ulcers
-residual limb shaping after amputation
-control of hypertrophic scarring (after burns)

Question 9

what are the causes of edema?

Answer 9

-imbalance between hydrostatic and osmotic pressure inside and outside of vessels
-venous or lymphatic obstruction or insufficiency
-increased capillary permeability
-immobility
-pregnancy
-systemic diseases (do not treat with compression)

Question 10

how does the lymphatic system work?

Answer 10

-help prevent the accumulation of fluid.
-it is a large system of vessels and nodes that act as an accessory channel that returns lymph fluid to the blood circulation via emptying into the subclavian vein.
-the fluid in the blood is then excreted through kidney functions.
-lymph flows due to higher concentration of proteins within the lymphatic vessels compared to the interstitial space.

Question 11

what can cause reduced lymphatic flow and result in lymphedema?

Answer 11

-decreased levels of plasma proteins such as albumin
-mechanical obstruction of the lymphatics
-abnormal distribution of lymphatics or nodes
-reduced activity

Question 12

what can result from prolonged edema?

Answer 12

-decreased ROM
-function impairments
-pain
-disfiguration
-infection
-ulceration
-amputation
-itching
-brown skin pigmentation

Question 13

how does compression reduce edema?

Answer 13

-increases extravascular hydrostatic pressure = circulation promotion
-may move fluid proximally through the vessels

Question 14

how can compression aid in the prevention of DVT?

Answer 14

-can increase circulation and reduce DVT formation
-effect is greatest when used in combination with other DVT prophylaxis
-DVT increases with reduced local circulation

Question 15

how does compression aid with venous stasis ulcers?

Answer 15

-improves venous circulation
-improves rate of healing of venous stasis ulcers
-multilayered compression more effective than single layer
-high pressure more effective than lower pressure

Question 16

what is the cornerstone of venous ulcer treatment?

Answer 16

compression therapy

Question 17

what is the main contraindication for compression therapy?

Answer 17

-Ankle brachial index must be done to rule out arterial insufficiency
-ABI must be >0.8mmHg

Question 18

what are the contraindications for intermittent or sequential compression pumps?

Answer 18

-heart failure or pulmonary edema (due to risk of system overload)
-recent or acute DVT thrombophlebitis or PE (can dislodge and cause HA or PE)
-obstructed lymphatic or venous return (can be helpful after obstruction is removed)
-severe PAD (can further impair circulation)
-acute local skin infection (increases temperature and moisture to the area)
-significant hypoproteinemia (can further decrease protein concentration which can cause cardiac or immune disfunction)
-arterial revascularization

Question 19

what are the precautions of compression therapy?

Answer 19

-impaired sensation or mentation
-uncontrolled hypertension
-cancer
-stroke/significant cerebrovascular insufficiency
-superficial peripheral nerves

Question 20

what are the adverse effects of compression therapy?

Answer 20

-aggravate condition causing edema
-impairing circulation with excessive pressure
(shortness of breath can occur which indicates overload in the lungs or PE)

Question 21

what mmHg should compression be for DVT prevention?

Answer 21

16-19 mmHg
worn 24hrs/day

Question 22

what mmHg should compression be for scar tissue control?

Answer 22

20-30 mmHg

Question 23

what mmHg should compression be for edema control?

Answer 23

30-40 mmHg

Question 24

what are the disadvantages of intermittent pneumatic compression pump?

Answer 24

-only used for limited times
-cant be used for scar formation
-requires static compression to be used between treatments
-expensive
-patient cannot move during treatment
-can aggravate acute conditions

Question 25

what do you need to document when using compression treatment?

Answer 25

-type of compression
-area of the body where compression is applied
-patient position
-inflation and deflation times
-compression or inflation pressure
-treatment duration
-response to intervention