Intermittent Pneumatic Compression Therapy. NSW PAR - 13 th March 2009 - Blue Mountains Craig Evans Physiotherapist Rankin Park Limb Centre. Current Oedema Management Options. RRDs Silicone liners Shrinkers Bandaging Prosthesis Intermittent Pneumatic Compression Therapy (IPC).
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NSW PAR - 13th March 2009 - Blue Mountains
Rankin Park Limb Centre
Intermittent Pneumatic Compression Therapy (IPC)
Sequential – number of chambers
Duration , intensity (pressure) , Rx/rest phases
1 unobtainable Article!!!
Experiences in the use of a pneumatic stump shrinker.
Author: REDFORD JB Journal: ICIB Issue: 12(10), 1-6, 14 Year: 1973 Description: Describes methods used to reduce stump oedema occurring after amputation. Includes the Jobst intermittent compression unit which is applied to reduce oedema prior to casting the amputation stump for a temporary or permanent socket. Rigid- plaster dressings have been used satisfactorily, as has Tensor bandage wrapping and lycra tubigrip stump socks. Reduction of oedema allows the patient to be fitted with a permanent prosthesis in 40 to 60 days.
Inter-Clinic Information Bulletin (ICIB) was initiated in 1961 in the US to improve timely information sharing between prosthetic and orthotic clinics for children. Now known as Clinical Prosthetics and Orthotics
More effective on TTAs than TFAs
? Desensitization effect
Used in other centres / states for over 30 years
The Lymphoedema Framework (2006)
IPC recognised as an effective treatment
Multi-chambered IPC > single chambered
Other compressive therapy / garments to prevent rebound
Kakkos / Nicolaides / Griffin / Geroulakos / Wolfe / ....collaboration
“... is as effective as heparin” (Nicolaides et al 1980)
Lacks hemorrhagic side effects of anticoagulants – better option in trauma, brain injury (Kakkos et al, 2005)
Potentially effective at preventing venous stasis and therefore DVT (Kakkos et al, 2000)
Nelson Mani and Vowden (2008) Cochrane Review – 7 RCTs on venous ulcers
IPC may increase healing compared with no compression.
not clear whether it increases healing when added to treatment with bandages
Rapid IPC is better than slow IPC in 1 trial
Ginsberg et al (1999)
Delis et al (2000)
Delis et al (2001)
Decompensating heart insufficiency (?CCF)
Extensive thrombophlebitis, thrombus or suspected thrombus
Infectious disease (?infection)
Acute soft tissue trauma to the extremities
(Wienert et al, 2005)
Peroneal nerve palsy/neurovascular compression
(Wienert et al, 2005)
Multi chambered unit
Preset cycles (28:11)
Up to 30 mins
1 week to 2-3 months post op
Infection control procedures
Fit of prosthesis / RRD
CAD CAM digitizer / scanner
Doppler / Duplex / ABPI (ankle brachial pressure index)/ tcPO2
Ginsberg, Magier, Mackinnon and Gent (1999). “Intermittent compression units for severe post-phlebitic syndrome: a randomised crossover study.” CMAJ, May, 160(9), 1303-1306.
Nelson EA, Mani R, Vowden K. Intermittent pneumatic compression for treating venous leg ulcers. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD001899. DOI: 10.1002/14651858.CD001899.pub2.
Gilbart, Oglivie-Harris, Broadhurst and Clarfield (1995). “Anterior tibial compartment pressures during intermittent sequential pneumatic compression therapy.” American Journal of Sports Medicine, 23(6): 769-772
Engstrom, B., Van de Ven, C.. (1999). “Therapy for Amputees” (3rd Edition) Churchill Livingstone.
Kakkos, Griffin, Geroulakos and Nicolaides (2005). “The efficacy of a new portable sequential compression device (SCD Express) in preventing venous stasis.” Journal of Vascular Surgery, 42(2): 296-303.
Kakkos, Szendro, Griffin, Daskalopoulou and Nicolaides (2000). “The efficacy of the new SCD Response Compression System in the prevention of venous stasis.” Journal of Vascular Surgery, 32(5): 932-40.
Delis, Nicolaides, Wolfe and Stansby (2000). “ Improving walking ability and ankle brachial indicies in symptomatic peripheral vascular disease with intermittent pneumatic foot compression: a prospective controlled study with one-year follow-up.” Journal of Vascular Surgery, 31(4): 650-661.
Delis, Husmann, Cheshire and Nicolaides (2001). “Effects of intermittent pneumatic compression of the calf and thigh on arterial calf inflow: a study of normals, claudicants and grafted arteriopaths.” Surgery, 129(2): 188-95 Feb (abstract only)
Nicolaides, Fernandes, Fernandes and Pollock (1980). Intermittent sequential pneumatic compression of the legs in the prevention of venous stasis and postoperative deep venous thrombosis.” Surgery, 87(1): 69-76, Jan. (Abstract only)
Wienert, Partsch, Gallenkemper, Gerlach, Junger, Marschall and Rabe (2005). “Guideline: Intermittent pneumatic compression.” Phlebologie, 34(3): 176-80 (German)
Lachmann, Rook, Tunkel and Nagler (1992). “Complications associated with intermittent pneumatic compression.” Archives of Physical Medicine and Rehabilitation, 75(5): 482-5. (Abstract only)
Lymphoedema Framework (2006) . Best Practice for the Management of Lymphoedema. International consensus. London: MEP Ltd.