Compression Therapy and ABI Values – Flashcards
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Compression Physiology
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- Reduces diameter of veins, causing endothelial cells to become tighter therefore reducing fluid leakage from the veins - Produces increase in blood flow toward heart and reduces venous reflux
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Compression Physiology The degree of compression is determined by:
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- Elasticity of bandage - Number of bandage layers - Shape and size of limb - Skill and technique of clinician - Nature of physical activity undertaken by patient
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Laplace's Law
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Sub-bandage pressure is directly proportional to bandage tension but inversely proportional to the radius of the curvature of the limb to which it is applied
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Increased bandage tension and increased # of bandage layers =
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Increased sub-bandage pressure
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Increased leg circumference and increased bandage width =
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Decreased sub-bandage pressure
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Bandage Types Long Stretch
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- Ace Wrap - Used for more aggressive compression
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Bandage Types Short Stretch
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- Lymphedema bandages - Safer than long stretch due to less extensibility and therefore less tension to limb
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Bandage Types Inelastic
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- Unna boot - Hardens after application like a cast, forming a rigid compression bandage
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Resting Pressure vs. Working Pressure
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Resting Pressure: pressure bandage exerts on the tissues at rest Working Pressure: pressure bandage exerts against working musculature
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Compression Precautions
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- DM (decreased sensation) - PVD/Arterial insufficiency - Acute cellulitis/infection - Neuropathy - Acute CHF - Low Ejection Fraction - Fragile Skin
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How much compression is safe?
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ABI = 0.5 or less (NONE! Compression is CONTRAINDICATED) ABI = 0.6 - 0.8 (Modified compression can be applied, 20-30 mmHg) ABI = > 0.8 (Normal compression can be applied, 30-40 mmHg) ABI = > 1.3 (Unreliable due to calcification of vessels)
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Compression Stockings are indicated for legs with:
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History of ulcers Edema or risk of edema Varicosities or spider veins History of DVTs History of cellulitis (NOT for legs with open wounds)
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4 Classes of Compression Stockings
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15-20 mmHg 20-30 mmHg 30-40 mmHg (best for venous etiology) 40-50 mmHg (usually best for lymphedema)
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How to instruct patients on compression stocking use
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Wear during waking hours, when out of bed Do not moisturize prior to applying, moisturize at night instead
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Compression Alternatives
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- Inelastic adjustable compression garments, ie. CircAid, Farrow wrap - Flat-knit custom garments - Multi-layer compression stockings - Custom compression stockings - Intermittent pneumatic compression (IPC) pump
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Patient Education on Compression Wraps and Stockings
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- Wound recalcitrance (high recurrent rate) - Elevation of LEs above heart when sitting or lying - No prolonged standing but encourage walking - Importance and purpose of wraps and stockings - Monitoring for changes such as CHF, cellulitis and vascular status
