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Pneumatic Compression Therapy

It’s Not Just For Lymphedema Anymore

The simple description for pneumatic compression therapy is: the application of a pneumatic garment, usually a leg wrap or arm wrap, to an extremity. The garment is attached to an air pump which inflates and deflates the garment in a specific, calibrated, timed sequenced manner for the purpose of achieving a variety of therapeutic effects. Most people think of this modality as a treatment for lymphedema only, but this is not the case.

This is 2013, and it’s not your father’s compression therapy anymore. There are three distinct types of compression currently available, indicated for several different types of therapy: lymphatic, vascular and arterial. The purpose and scope of this article is to familiarize the reader with each of these modalities and their applications, so that when the need for compression arises, access of the equipment is rapidly facilitated and not delayed due to confusion or lack of understanding. Unfortunately many prescribers simply scribble "compression booties" on the Rx pad or doctor’s order, and leave it up to the nurses and other care givers to figure out what is needed.

Systems for Treatment of Lymphedema

These systems produce compression, via a very slow inflate/deflate cycle, designed to create a milking action which forces the lymphatic fluid retained in the tissue of the extremity by a compromised lymphatic system, into the thoracic duct and then to the bloodstream, where it is then recirculated back to the tissues. The resultant reduction in swelling greatly reduces the patient’s discomfort, lowers the risk of infection, minimizes the incidence of fibrosis, and improves the patient’s quality of life. Shown below are the before and after pictures to provide you some idea of the results which can be achieved by compression therapy.


Most lymphedema systems are available with a variety of leg and arm sleeves, in a choice of sizes which fit most patients.  There are a few manufacturers offering custom sewn sleeves for very large or very small patients, and hand sleeves or gloves and foot sleeves or boots for certain unusual situations. A competent equipment dealer can be invaluable in acquiring these types of specialized equipment. It should be noted that in actual practice, leg sleeves, which may or may not cover the foot, are very often referred to by the shorthand term "booties" or "boots". When the treatment is for the lower extremities and the prescriber has simply written "compression boots" or something similarly vague, the prescriber should be contacted for confirmation as to the exact type of garment intended; foot, lower leg, or full leg.

Lymphedema systems are available in two specific styles: intermittent compression and sequential compression. Again, just as in the configuration of the sleeves, this choice is often left to the nurse. A competent equipment dealer will advise the nurse to get back to the prescriber for confirmation on whether intermittent or sequential compression is intended.

Intermittent Compression: In this modality the entire sleeve or wrap inflates and deflates; there are no chambers within the sleeve to inflate sequentially. This is usually the first modality of choice since the cost is slightly lower. In stubborn cases where intermittent compression does not achieve the desired clinical outcome, it is necessary to switch to the more effective sequential compression.

Sequential Compression: This modality utilizes sleeves with a number of chambers, usually three or four, although several specialized manufacturers offer garments with up to twelve chambers. These chambers inflate distally to proximally assuring thorough and complete forcing of the lymphatic fluid back into the thoracic duct and thence to the bloodstream. Some sequential systems available have a calibrated air pump which provides a separate air hose to each chamber. Many of these systems are configured this way to allow separate calibration of pressure in each chamber. Other sequential systems do not offer this option, some simply having each chamber inflated to factory pre-set pressures. These systems are popular because while they are still more effective than simple, intermittent compression, they are still less costly than those which require careful calibration of each individual chamber, which are seldom needed. Some manufacturers are turning to an even more economical version of sequential compression known as "gradient sequential compression". Rather than an expensive system with separate air hoses for each chamber, a sleeve is configured with chambers that contain internal valves which bleed one into the other, starting with the distal most chambers and progressing proximally. This usually produces the same therapeutic result without the added cost of a complex air pump capable of providing multiple air outlets with different pressures.

Finally, it should be noted that lymphatic style compression and venous style compression are both indicated for treatment of chronic, slow healing wounds such as venous stasis ulcers; however this matter is the subject of some controversy among wound care specialists.


Contraindications

Patients with presumptive evidence of Congestive Heart Failure or suspected pre-existing Deep Vein Thrombosis should NOT use pneumatic compression therapy, as serious injury or death may occur.

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: 9/3/2013 9:32:08 AM
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