Intermittent Compression
By
Jason, Brad, Tim, Yasuko
Objectives
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Purpose of Intermittent Compression
Proper application
When to use intermittent compression
Discussion of Effectiveness
Factors affecting usage of intermittent
compression
Instructions
• Click on hyperlink to view slides of each topic
or concept
• Use hyperlink at bottom of page to return to
topics page
• Voice over
Topics
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History
Biophysical Characteristics
Method of Application
Examination of Evidence Based Research
Review Questions
References
History
• Add Voice Over
• Various forms of intermittent compression have had a
history of 70 years of clinical effectiveness.
• Earliest appeared in 1930’s
Topic page
Biophysical Characteristics
1. Effects on Lymphatic and venous system
– Mechanical pressure encourages blood to
return to the heart through the venous
system
– Spreads edema proximally over a larger
area to allow more lymphatic ducts to
absorb the solid matter within the edema
2. Topic page
Biophysical Characteristics
cont.
1. Effect of intermittent compression
a. Tissue
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The gradient between tissue hydrostatic pressure
and the capillary filtration pressure is reduced
Second pressure gradient is formed between
distal portion of extremity and the proximal
portion of the extremity forcing fluids to move to
the proximal portion
Tissue thickness and muscle mass increases
Fat mass decreases but not significantly enough
for any clinical importance
Bone mineral density- no significant effect
Biophysical Characteristics
cont.
Range of motion
• Increased from compression
Pain
• Video
Method of Application
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Indication
Contraindication
Precautions
Recommendations for use
Proper demonstration of physical agent
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Video
Video
Topic page
Method of Application
Indications
– Post-traumatic edema—
– Post-surgical edema—
– Primary and Secondary lymphedema— Primary is
caused by a congenital disorder of the lymphatic
vessels. Secondary is caused by some other disease or
dysfunction.
Method of Application
Indications
– Venous Stasis Ulcers— Areas in the body in which
tissue breakdown and necrosis occur as a result of
impaired venous circulation.
– Prevention of Deep Vein Thrombosis (DVT)— DVT
is a blood clot that occurs due to poor circulation.
Blood flow is slow enough to allow coagulation,
causing a thrombus. Intermittent compression
increases the circulation rate thereby preventing a
clot from forming.
Method of Application
Contraindications
– Heart failure or pulmonary edema— Increased
pressure from the compression device damages
the vasculature of the cardiovascular system
decreasing the cardiac output.
– Recent or acute DVT, thrombophlebitis,
pulmonary embolism— The thrombus may
become dislodged or the embolus may travel due
to compression at the site of the clot. This would
cause damage to the site where it becomes
lodged after traveling through the bloodstream.
Method of Application
Contraindications
• Obstructed lymphatic or venous return— Total
obstruction of lymphatic or venous system may
be caused by thrombus, damaged lymph nodes,
tumor or other masses. The obstruction must be
removed before compression can be applied.
• Severe peripheral arterial disease or ulcers due to
arterial insufficiency— Compression further
closes down the diseased arteries causing lack of
circulation.
Method of Application
Contraindications
• Acute local skin infection— Device promotes
environment conducive to infection, by
increasing moisture and temperature.
• Unhealed fractures and unresolved joint
dislocations— compression device adds
unwanted stress to the area.
Method of Application
Precautions
• Impaired sensation or mentation— Patient is
unable to recognize or feel pain or pressure.
• Uncontrolled hypertension— Compression
may further elevate a persons blood pressure.
• Stroke or significant cerebrovascular
insufficiency— Compression causes
hemodynamic changes and alters circulation
to the brain.
Method of Application
Precautions
• Superficial peripheral nerves— Nerve
compression is possible when too much
pressure is applied.
• Ischemia— compression elevates
intramuscular pressure causing ischemia,
similar to compartment syndrome.
• Wrinkling of stockinette— Wrinkles cause high
pressure areas and subsequent bruising.
Method of Application
Demonstration of Physical Agent Set up
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Establish the absence of contraindications.
Remove any jewelry
Determine blood pressure
Measure and record girth measurement
Cover area with stockinette, smooth out wrinkles
Select appropriate size of appliance for extremity
Insert the injured limb into the appliance, avoid
bunching of garments
• Elevate the limb during treatment
• Connect appliance to the compression unit
Method of Application
Initiation of Treatment
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Select temperature
Select maximal pressure for associated extremity
Select on/off times
Select appropriate treatment time
Informed consent
Encourage gentle ROM exercises at distal
phalanges
• For longer treatments, interrupt occasionally to
inspect capillary refill or unusual markings
Method of Application
Termination of Treatment
• Select drain mode to remove air or fluid
• Gently remove body part from appliance
• Re-measure circumference to determine
amount of edema lost
• Apply compression wrap and any appropriate
supportive device. Encourage elevation.
Properties of Intermittent
Compression Systems
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Garment
Pumps
Timing
Pressure
Compression type
Properties of Intermittent
Compression Systems
• Garment
– Essential functions that the compression garment
must provide include: covering a limb, remaining in
place, and applying pressure.
– All cuffs of today include an air bladder.
– Need to be made of certain material that is designed
for the specific use of the patient.
• Deep Vein Thrombosis cuffs are designed for single use
patients
– Non-durable fabrics
• Long term cuffs designed to be more durable and
comfortable.
Properties of Intermittent
Compression Systems
• Pumps
– All current pumps are electrically driven with a
few battery operated. This trend is due to
simplification.
Hand Pump
Electrical Pump
Properties of Intermittent
Compression Systems
• Timing
– Generally, intermittent compression for DVT and
arterial disease will have a shorter compression
time than deflated time between compressions.
– Adequate venous refilling must take place,
therefore most devices have a decompression
time of 40 seconds or greater.
– 3:1 Duty cycle
Properties of Intermittent
Compression Systems
• Pressure
– The pressure applied during intermittent
compression is always a compromise between
efficacy and patient comfort.
– Generally average of 40 mm Hg
– Pressure changes depending on body part, lower
extremity usually requires higher pressure than
upper extremity.
Properties of Intermittent
Compression Systems
• Compression type
– Circumferential
• Applies equal amount
with pressure to all parts
of extremity
simultaneously.
– Sequential
• Device contains multiple
bladders that allows for a
single pressure to be
applied to parts of the
limb in sequence from
distal to proximal.
Examination of Evidence Based
Research
Cambier et al, (2003) found that the use of intermittent pneumatic compression
in the rehabilitation of stroke patients may be of clinical importance for the
restoration of sensory function.
Morris et al, (2006) Although the data confirms that both types of intermittent
compression suppress procoagulant activation, and that the rate of inflation
produced no extra benefit in increasing global fibrinolysis, and my be less
hemologically effective.
Tsang et al, (2003) found that elevation or elevation with intermittent
compression did not effectively decrease ankle volume for a proloonged period of
time in patients with postacute ankle sprains. The therapeutic effects lasted less
than 5 minutes after the limb was returned to a gravity dependent position.
Topic page
Review Questions
Topic page
References
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Morris, R. J. (2008). Intermittent pneumatic compression-system and applications. Journal of Medical
Engineering & Technolog , 179-188.
P.Albertazzi, S. S. (2005). Effect of intermittent compression therapy on bone mineral density in women
with low bone mass. Bone , 662-668.
Starkey, C. (2004). Therapeutic Modalities. Philadelphia: F.A. DAVIS COMPANY.
Tsang, Kavin K.W., Hertel, Jay, Denegart, Craig R. (2003). Volume Decreases After Elevation and
intermittent Compression of Postacute Ankle Sprains Are Negated by Gravity-Dependent Positioning.
Journal of Athletic Training, 38, (4), 320-324.
Prentice, W.E. (2008). Therapuetic Modalities in Sports Medicine (6th ed.). St. Louis, MO: Mosby-Year
Book.
Cameron, M.H. (2003). Physical Agents in Rehabilitation: From Research to Practice (2nd ed.). St. Louis,
MO: Saunders.