Treating Edema

IPC parameters: inflation pressure for UE

30-60 mmHg

IPC parameters: inflation pressure for LE

40-80 mmHg

Long stretch bandage

Ace wrap, tubigrip -provides high resting pressure (exerted by elastic when it is put on stretch) -can extend 100-200% -when stretched it provides 60-70mmHG -most effective for immobile pts or limbs -apply with moderate tension to avoid excessive resting pressure which may impair circulation

Static compression

Bandages, garments -used to help control edema caused by venous or lymphatic dysfunction or inflammation, to form the shape of amputated residual limbs in preparation for use of a prosthetic device, or to control scar formation after burn injury -helps prevent DVT in pt with low mobility -generally applied after intermittent compression to maintain edema control

How to know if it is edema

Edema is the bodys natural response to injury or inflammation and is the result of fluid from "leaky" blood vessels being released into neary tissues. This fluid accumulates and causes the tissue to swell. Edema is mostly water so you can think of edema as being soft and squishy, more acute, like from a strain, sprain or new injury

How to know if it is lymphedema

Lymphedema is a condition that is most commonly caused by the removal of or damage to the lymph nodes, often as a result of cancer treatment or infection. Swelling occurs when lymphatic rich or protein rich fluid is unable to drain properly. Theres an excess load of fluid, water, and protein molecules and can occur in the extremities, trunk and face. the water gets pulled out, but the protein is too heavy and gets left behind by a sluggish lymphatic system. Then, this protein pulls more water toward it, and the cycle of lymphedema continues.

Documentation of edema

O: limb treated, edema measurement values and how provided, parameters for compression pump and purpose, type of bandage or garment give and purpose, pt education (elevation, re-wrap, safety on tightness) A: goals, compare today measurements, pt tolerance, justification of services.

IPC parameters: On/Off time for residual limb reduction

ON: 40-60 sec OFF: 10-15

IPC parameters: On/off time for edema or venous stasis ulcers

ON: 80-100 sec OFF: 25-50

How to treat acute injury edema

RICE: rest, ice, compression and elevation -Electrotherapy MVPC -Gentle ROM -kinesiotaping

Maintenance of compressive devices: compression pumps

- if garments are re-used in clinic, must be wiped down with bacterial wipes -if taken to pts room, pump must be wiped down with bacterial wipes after each use.

Maintenance of compression devices: bandages

-Ace wraps and Comprilan--don't generally hold up well in the wash. Can wash but tend to lose elasticity and shape. -Coban-Dispose of after use -Kerlix gauze-Dispose of after use -Can be layered to protect skin, provide increased compression

Compression Garments

-Anti-embolism stockings: TED hose (24/7) -Garments: support hose, support sleeves, stump shrinkers, tensoshape, lymphedema garments, Jobst products, custom fit or over the counter -Must be replaced when significant decrease in limb size has occured -bandages first to reduce and then garments to maintain

Maintenance of compressive devices: Garments

-Jobst-Generally can be hand-washed -Stockinette-Can be washed but will eventually lose elasticity and shape -Garments with Velcro-Hand wash or machine wash separately.

Indications for compression

-Prevention of DVTs -Prevention and treatment of venous stasis ulcers -limb reshaping and maintenance of stump size following amputation -control of hypertrophic scarring (burn victims) -Pain reduction -improved functional mobility due to downsizing of affected area -cosmesis (improving self image)

How to know if it is arterial insufficiency (not okay)

-Results in poor blood/fluid flow from trunk to extremities -compression is contraindicated. -*****CLAUDICATION: pt experiences significant pain with walking distances up to 100ft. -Swelling usually not noted -Pt will have pain when legs elevated -compression and elevation are contraindicated bc both can lead to progression of impaired circulation

Contraindications for compression

-blockage or lymphatic or venous return -active infection -malignancy -peripheral edema from CHF or cardiomyopathy -symptomatic heart failure -thrombus -pulmonary edema -peripheral artery disease -ulcers from arterial insufficiency -hypoproteinemia -acute trauma or fracture -arterial revascularization -*****arterial insufficiency

Other treatments for edema

-compression pumps: IFC -compressive bandages -massage -exercise -kinesiotaping -dietary changes -medications: diuretics -surgical

IPC: Intermittent pneumatic compression pump

-introduced if static compression has been unsuccessful for 6 months -generally not used for control of scare formation due to the need for constant compression -controversial for lymphedema treatment

Lymphedema massage

-light and gentle to facilitate removal of excess fluid in interstitial spaces -manual technique to redirect lymphatic flow toward healthy lymph nodes and into the venous system -generally applied after ther ex to maximize benefit -can instruct pt and/or caregiver to perform

Lymphedema massage continue

-light, rhythmic, slow, moves the skin -towards desired direction of lymphatic flow -skin stretch then release -specific strokes: L and long stroke -Proximal to distal. begin with massage to area with lymph nodes, work outward and distally

Edema massage

-must clear heart and kidneys first -longer, deeper strokes impacting deeper tissues -DISTAL to PROXIMAL Ex: fingers to chest; toes to pelvis -Move edema from area of pathology to normal functioning region proximally -Elevate the area during massage

Precautions for compression

-neuropathy (no feeling at all) -altered sensation or mentation -uncontrolled hypertension -cancer -stroke -over superficial peripheral nerves -too much pressure (can act like a tourniquet)

How to know if it is venous insufficiency (okay for compression)

-results in poor blood flow/fluid flow from extremities to the trunk -ulcers are best treated with compression -note swelling in affected limb -Dependent edema: swelling when appendage is lower than the heart -Responds well to compression and elevation -Compression 24/7 besides bathing

Short stretch bandage

Unnas boot, comprilan, coban -Provides high working pressure (produced by active muscles pushing against an inelastic bandage and is produced only when the pt is moving and contracting the muscle

Intermittent comrpession

electrical pneumatic pumps -helps prevent DVTs -can be used with static compression -used primarily to prevent or reduce edema formation in limbs with poor venous or lymphatic drainage and is followed by bandages or garments to maintain.

How to wash compression garments

hand wash and air dry

IPC parameters: total treatment time

range from 1-4 hours, multiple times a day, 2-5x a week

ABI (ankle brachial plexus) scores

tests for peripheral arterial disease -Normal: 1-1.4 -PAD: .90 or less -Severe PAD: .50 (compression contraindicated)