Lymphedema and Pneumatic Compression Systems

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Indications for Use

  1. Lymphedema: As an alternative and/or adjunct to CDT (complete decongestive therapy treatment).
  2. Edema caused by chronic venous insufficiency.

Note: Pneumatic Compression Systems are best avoided for many non- lymphedema states (edema) due to the nature of the disease causing the edema (often heart failure, nephrotic syndromes, acute DVT) which are contraindications for compression system

Contraindications for Use

  1. Active infection
  2. Lymphatic malignancy
  3. DVT and/or Thrombophlebitis
  4. Renal failure
  5. CHF
  6. Body wide edema
  7. Pleural effusion
  8. Prone to pulmonary embolism
  9. Cirrhosis

Using the Compression System with Wounds

Compression systems may be used with open wounds IF the wound remains dressed/covered during the treatment and no active, untreated infection is present.

Types of Pumps

  • Intermittent Compression System (see user manual for operation)
  • Sequential Circulator (see user manual for operation)

Physical Therapy Recommended Operation and Settings

  • Prior to applying boot/sleeve: apply a cotton stockinette or lightweight, non-binding sock over the extremity.
  • Patient positioning: Patient should be lying down to allow the flow of fluid being compressed to flow through the lymphatic/venous system efficiently.
  • Treatment time: Start with 20-30 minutes. If there are no complications (numbness, pain, skin damage, increased swelling), increase time by 10 min each session up to one hour 1-2x/per day.
  • Pressure setting: Start with 20mm/Hg. Increase by 5 mm/Hg intervals each session if no complications, to a MAXIMUM of 30 mm/Hg.
  • On/Off cycles: 30 seconds on, 10 seconds off if settings are not pre-set.

Physical Therapy’s Role in Compression Treatment

Physical Therapy is often involved to evaluate for the following:

  • Appropriateness of compression system use
  • CG/RN training on operation of compression system
  • manual lymphedema treatment
  • transfer and gait training
  • fall prevention
  • ROM and strengthening

Process for Involving Physical Therapy in the Patient’s Plan of Care

  1. An order for “physical therapy to evaluate for lymphedema management” should be requested by the RN.
  2. The Physical Therapist will schedule an appointment with the patient and determine the plan of care.
  3. The Physical Therapist will contact the Team/RN to recommend appropriate DME (if not already ordered by RN or MD).
  4. DME to deliver compression system.
  5. Team/RN to notify Physical Therapist when DME has been received by patient.
  6. The Physical Therapist will arrange a joint visit (if possible) to provide CG,RN and patient training on use of compression system. PT will also provide USER MANUAL copy to the patient.
  7. If the Physical Therapist determines additional physical therapy is needed to address mobility issues in addition to compression therapy, the Physical Therapist will proceed with the plan of care.
  8. If the Physical Therapist determines additional physical therapy is not indicated, the RN will follow-up with monitoring the patient’s response to the compression system and refer to the Wiki Pages and User Manual for questions regarding the use and operation of the compression system. As always, the RN may contact the Physical Therapist for assistance.

 

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