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Pneumatic Compression Therapy Part 3

Arterial Compression for Wound Healing and Limb Salvage

The first part of this series discussed the fact that there are three distinct modes of pneumatic compression therapies and they have explained that the purpose of this series is to educate nurses and other caregivers about these various systems, since they are not well known or well understood in the general health care professional community.

This lack of understanding in compression therapy can cause confusion and uncertainty. The lack of knowledge results in a delay in providing the patient with the appropriate therapy, particularly when the prescribing physician scribbles a vague order such as "compression booties", leaving the nurse to try to decipher what is meant.

Arterial Disease

Arterial Disease, also known as Peripheral Artery Disease (PAD), is quite simply compromised blood flow in an extremity. This can cause plaque to build up in the arteries that carry blood to the head, organs, and limbs. Arterial Disease usually affects the arteries in the legs, but it can also affect the arteries that carry blood from the heart to the head, arms, kidneys and stomach. Some of the main risk factors for Peripheral Arterial Disease are smoking and diabetes.

Our concern, with respect to pneumatic compression and PAD, is the issue of compromised blood flow in an extremity causing pain and numbness. Usually diagnosed as Critical Limb Ischemia, this raises the risk of the patient developing non-healing ulcers in the affected limbs. It is then a short process to contracting an infection which can become gangrenous, leading to limb amputation.

By the time a situation such as these develops, the patient will most likely be under the care of a competent wound care practitioner. The Long Term Care nurse now has to care for a patient with conditions that deal with arterial compression equipment for which she has limited knowledge.

There is a need for a general overview of pneumatic compression equipment that includes a brief explanation of this type of equipment and how it functions. The knowledge of PAD and the equipment used to treat it will aid the Long Term Care nurse in discerning the early signs of PAD, and taking appropriate action.

Early Signs of PAD:
  • Two of the main risk factors of Peripheral Arterial Disease are smoking and diabetes. LTC residents who have diabetes and/or a history of smoking should be watched carefully for the following early signs:
  • Pulselessness of the extremity
  • Painful ulceration
  • Small, punctuate ulcers that are usually well circumscribed
  • Cool or Cold skin
  • Delayed capillary return time (briefly push on the end of the toe or finger and release, normal color should return to the toe or finger in 3 seconds or less)
  • Atrophic appearing skin (shiny, thin, dry)
  • Loss of digital and pedal hair
  • Can occur anywhere, but is frequently seen on the dorsum (top) of the foot
Arterial Systems for Wound Healing and Limb Salvage

Identifying arterial compression equipment is not straightforward, since arterial systems appear to look almost identical to vascular systems, and even appear quite similar to lymphatic systems to the untrained eye. The important differences are pressure and duration of inflation/deflation. Arterial pumps should provide sequential compression with pressures up to 120 mmHg. Inflation and deflation rates are much more rapid than non-arterial pumps, well under 0.5 seconds, or 180 times per hour. When treating the lower extremities, as opposed to lymphatic or vascular compression where the patient can be reclining or supine, the patient should be sitting upright. Patients being treated on the upper extremities may sit or recline, as preferred.

The two photos below are showing a patient in danger of amputation with necrotic wounds taken in October, 2002 and then treatment progression by March, 2003. This graphically illustrates why arterial compression systems are aptly nick-named "the limb savers".



The photos below will give the reader a good visual overview of the range of arterial systems currently available. While the patients under treatment are depicted in a home setting, those working in Long Term Care will probably see their resident taken by vehicle to the nearest wound care center. Some LTC facilities are opting to eliminate this inefficient method for providing wound care and are establishing in-house wound care centers. In either case, it is very helpful for the LTC nurse to have the rudimentary knowledge of PAD and arterial compression systems presented here.

          


         
                                               
All medical professionals are welcome to call Vascular PRN at 800-886-4331, any time, if they have questions regarding any type of pneumatic compression system. Vascular PRN specializes strictly in Pneumatic Compression and has amassed a sufficient knowledge base in this subject to enable us to advise the care giver in any aspect of the use, care and application of these systems. Additionally, Vascular PRN offers Long Term Care facilities, hospitals, ambulatory surgery centers and other medical institutions economical short term rental of most of our systems and overnight delivery in most cases.

Guest Article by Greg Gambor co-owner of Vascular PRN, a company which supplies pneumatic compression therapy equipment to nursing homes, hospitals, surgery centers and other medical institutions throughout the United States.

Greg Grambor is a graduate of Ramapo College of New Jersey, with a degree in communications. After serving as a medic and radio operator with the US 38th Air Defense Artillery in Song Hwan, Korea, from 1968 to 1970, Grambor spent almost 20 years in medical/industrial advertising on New York’s Madison Avenue. For eight of those years he was owner of an award winning medical/industrial advertising agency, Schachter, Grambor & Associates, Inc. This company worked on the introduction of the Pfizer ACTA Scanner, one of the world’s first commercially successful CAT scanners, and they also introduced the Elscint CAT scanner from Elscint Corporation of Israel to the American medical market, as well as the Varta Aviation Battery line of Germany to the American aviation market.

The company rounded out its stable of clients to include a hypodermic syringe manufacturer, a urologicals manufacturer and others. After moving to Florida in 1989 seeking a warm climate, Greg and his wife Diane owned a series of DME companies in the fields of oxygen, respiratory, polysomnography and diabetic testing supplies. The couple currently own and operate Vascular PRNK, a company which supplies pneumatic compression therapy equipment to nursing homes, hospitals, surgery centers and other medical institutions throughout the United States.The company is currently a National Distributor for ArjoHuntleigh Compression Therapy Equipment.

Greg can be reached at greg@medsupplyoftampa.net or via the company’s web site www.vascularprn.com on their “CONTACT US” page.

Posted: 10/29/2013 12:15:07 PM
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