Lymphedema Compression therapy

Pneumatic lymphedema compression therapy is a method of lymphedema management of the vascular system and muscle groups, particularly in the legs. This type of treatment is used in instances where other conservative measures such as lymphedema therapeutic manual massage, wearing compression garments, etc., fails to promote adequate blood flow.

Lymphedema therapy is administered using a sequential compression device (SCD) which consists of an automated controllable pump that is connected to an inflatable compression garment by a tube or set of tubes. While most SCDs come as complete units, each can be purchased separately.

Types of lymphedema pumps:

There are a variety of both medical lymphedema pumps and at home lymphedema pumps that vary in design but they all operate using the same principle. Most are multi-chambered and generally come with one or more controls that allows you to set the sequence and intervals of pumping air into an inflatable garment.

Single-chamber non-programmable pumps: These are the simplest pumps, consisting of a single chamber that is inflated at one time that applies uniform pressure.

Multichamber nonprogrammable pumps: These pumps have multiple chambers, ranging from 2 to 12 or more. The chambers are inflated sequentially and have a fixed pressure in each compartment. They can either have the same pressure in each compartment or a pressure gradient, but they do not include the ability to manually adjust the pressure in individual compartments.

Single- or multichamber programmable pumps: These are similar to the pumps described above except that it is possible to make manual adjustments in the pressure in the individual compartments and/or the length and frequency of the inflation cycles. In some situations, including in patients with scarring, contractures, or highly sensitive skin, programmable pumps are generally considered to be the preferred option.

Pneumatic compression pumps may be used in lymphedema clinics, or purchased, or rented, or an even more important role of the pump is that it can be used at home by a patient who has been trained in its proper use. If not used properly, it can force excess fluids into the surrounding tissues, therefore creating more problems.

Compression garments

Compression garment are available in various lengths and configurations, e.g., a boot-type you slip into, a wrap, or a sleeve. All contain inner chambers or pockets that are filled intermittently, or sequentially, with air by the pump. Typically all arm and leg garments are made from synthetic material.

How a pneumatic compression device works:

A pneumatic compression unit produces various pressure gradients to simulate the normal actions of the circulatory system by using external pressure. Inflation of the garment, both proximally and distally, produces pressure causing lymphatic fluids or blood to circulate out of the affected limb reducing swelling and preventing potential blood clots and wounds from forming.

The control unit inflates the sleeve’s inner chambers sequentially, or intermittently, at preset intervals, compressing the leg(s), starting in the ankle area and working upwards. (The more chambers a sleeve has, the better it can help promote circulation – a hospital-grade sequential compression garment may have up to 10 chambers while at home lymphedema compression garments will typically contain 6.)

This massaging effect imitates the natural flow of lymph from the distal end of the limb (foot) toward the trunk of the body, mimicking the action of leg movement, such as walking which moves blood and fluids through the veins towards the heart. The duration of compression is typically 11 seconds with a 60 second relaxation period between compressions depending on the brand of the unit and its configuration with air in a predetermined sequence.

Other uses for a Compression Devices for Lymphedema

• Promotes good circulation.
• Treats bruises and swelling resulting from orthopedic surgeries such as joint replacement
• Relaxes tense muscles.
• Stimulates muscles to keep you moving after long periods of inactivity.
• Eases stiffness.
• Relieves fatigue and muscle leg pains.
• Treating infected ulcerated legs
• Reduce swelling caused by lymphedema
• Preventing chronic venous insufficiency (CVI)
• Preventing deep vein thrombosis (DVT)
• Preventing venous ulcers
• Helping ambulatory, as well as non-ambulatory people, soothe sore muscles.
• Compression therapy for treatment lymphatic and venous disorders

Factors to consider before using a compression pump

The question about compression pumps is not whether they are effective in the movement of fluid. This has been clearly demonstrated and without a doubt they are extremely effective. The central problems are the possible complications they can cause: genital lymphedema because devices have not cleared the abdominal lymphatics before use of the pump, and damage to the superficial lymphatics. Pneumatic compression devices may not be a safe replacement for manual decongestive therapy by a certified lymphedema therapist or as a substitution in the use of compression bandaging. Instead pneumatic compression devices should be used as an adjunct for maintenance and should be included in the overall patient self-care program.

Should you use a sequential pump?

While there have been clinicians, therapists, and patients who have not had good results with lymphedema pumps and do not recommend their use, hundreds of people have experienced great results with the proper use of the right pumps. Lymphedema compression pumps are not for everyone, and success does depend on which pump is used or the proper application.

When you should not use a lymphedema pump

• If you have edema throughout your entire body
• If you have a blood clot
• If you have an active infection
• If you have (kidney)renal failure
• If you have active cancer
• If you have congestive heart failure
• If you are not applying manual lymph drainage

Note: Lymphedema pumps are also not normally recommended for babies, or children under age six.

Manufacturers of lymphedema compression Pumps

• Bio Compression Systems
• Tactile Systems Technology, Inc.
• LymphaPress
• Wright Therapy Products

Tips for selecting a Compression Device for Lymphedema:

1. Rely on your doctor’s recommendations on what type of scd devices you should purchase as there are several popular brands to choose from. (see below.) Such scd devices can be somewhat complicated to operate if you’re new to using them and may require assistance.
   It’s tempting to purchase an off-name brand to save a few dollars but if your doctor or health care physician who is familiar with your specific health situation makes a recommendation for a tested product for your situation, it’s advisable to follow his or her recommendation.
2. Don’t purchase a used or refurbished model – you don’t know what you’re getting! Going with a used model could put your health at risk if it doesn’t work properly. Buying a compression pump machine will be one of the most important purchases you make because it will help you live a longer and healthier life, allowing you to succeed at work and home and spend more time with family and friends. Unauthorized distributors may purchase your lyphedema compression device from a middleman. They may not work properly and you will never know. In addition, you may pay a significant amount without warranty coverage. The risk isn’t worth it.
3. Avoid websites that offer cheaper brands of Compression Device for Lymphedema. Instead look for a website that offers machines with warranties from the quality manufacturers and offers customer support. When you’re buying equipment that costs you or your insurance company hundreds to thousands of dollars you deserve access to customer support when needed.
4. Look for brands recommended by recognizable organizations, such as the American Diabetes Association (ADA). If you’re unsure about a specific brand contact the distributor or manufacturers directly for information about their product offerings, warranties, and customer service so you can compare.

If you are at risk for DVT or recovering from a recent acute DVT you should NOT use a SCD intermittently. Leaving it off for even 1-2 hours and then putting it back on may cause an embolus or blood clot(s). A SCD should only be used intermittently if bed-ridden. Any mobility, such as getting our of bed and sitting in a chair, if even for only an hour, the usage of an SCD should generally be discontinued. If continued, a Doppler may be used only if blood clots are not new.

Popular stand alone and portable lymphedema compression device:

Auto-Edema-Reduction-boot
This device typically includes a cold pack option to provide cold therapy as well as compression to the leg to treat injuries related to sports or rigorous activities. Some designs may include a grip sole to enable the user to walk while wearing the boot. This type of device can treat the entire lower leg and foot. Combined with the PresSsion sequential compression pump, it achieves the best of active and passive compression therapies.
 
 
The C-boot is not battery powered nor does it have external pumps, i.e. it is completely portable and depends on movement from your own body to generate power. It has three chambers that inflate using a mini-compressor that starts at the ankle and works upward and includes a section for the foot, which does not inflate.

The C-Boot, often referred to as a pneumatic sequential-compression boot, is recommended for the treatment of vascular conditions such as leg ulcers, chronic venous insufficiency (CVI) and stasis dermatitis, lymphedema, and for the prevention of Deep Vein Thrombosis (DVT).
 
 
Verseo Cordless Air Pressure Leg Massager - The Verseo Cordless Battery Powered Leg Massager is a nice little compact leg wrap that is designed to improve circulation and counteract conditions that contribute to deep vein thrombosis (DVT) and embolism, serious blood clot condition and is approved by the FDA to improve blood circulation for those who must sit for extended periods of time.

Because there are no bulky tubes and external pump the Verseo Cordless Leg Massager can be worn anywhere; just wrap it around your arm or leg, turn it on and let the gentle automatic inflation and deflation cycles massage away tension, stress and pain. It works by providing the same type of pressure as hospital compression boots, at a fraction of the time, cost, and inconvenience.

The massager delivers 70-130 mmHg of pressure, compared to the 15-20 mmHg delivered by compression stockings. It features 15-minute program and automatic modes, artificial-intelligence air pressure sensor, and three intensity settings. Fits calves and biceps up to 20″ in diameter. Requires two AA batteries (not included) that provide up to five hours of use. 4 1/2″ L x 2 1/2″ W x 2 1/2″ D.

Revitaleg Portable Pneumatic Compression Leg-Massager – RevitaLeg is an intermittent pneumatic compression massage device that helps improve circulation and reduces swelling caused by edema in the legs and feet for people who are inactive for long periods of time.

The RevitaLeg wraps around the leg and similar to an electric lymphedema compression device pump it delivers a massaging action by the inflating and deflating of its cuff. The squeezing of the muscles acts as a pump to help improve circulation in the lower leg and foot.

Huntleigh pneumatic compression device – This type of device is intended to treat lymphedema and venous insufficiency by delivering gradient segmental compression to the legs (also the arms).

It is available in a variety of sizes and is designed to prevent pinching and chafing.

The Huntleigh Gradient Segmental Compression System Garment comes with full-length zippers for easy application and removing (Console garments are sold as 1 garment per package, not sold in pairs.)

A bilateral connector is not needed to use two garments. The Huntleigh Gradient Segmental Compression System Garment is capable of providing arm and leg compression.
The measurement guidelines are simple one however the measurement will need to be done with some assistance.

The guidelines are as follows – Arm Length: Measure underarm to fingertips. Leg Length: Measure inseam thigh to heel.

Special Features:

• Increases venous and lymphatic flow
• Augments extracellular fluid drinage
• Reduces swelling and enhances wound healing
• Considerable reduction in ulcer size when used as an adjunct to the treatment of leg ulcers
• Features maximum comfort (soft and pliable)
• Washable
• Lightweight, portable pump features pressure gauge, pressure regulator dial, low pressure alert light, illuminated on/off switch, and hanging strap
• Ideal for home use

Specifications:
Power: 110-130v, 60Hz, 14W
Size: 10.5 x 3.5 x 4.5 inches
Weight: 3.75 pounds
Pressure Range: 30-70 mmHg
Cycle Time: Inflation 50 seconds, Deflation 70 seconds

DVTCare™

The “DVTCare” is portable (the pump weighs less than 1 lb.), has a battery that lasts up to 17 hrs on one leg or 8 hrs. on both (can be fully recharged in approx. 2.5 hrs.), and it can still be worn while it’s being recharged.

Insurance coverage for a sequential compression device

A lymphedema pump is a major expense; however most insurance plans, including Medicare, will approve the purchase of a pump as Durable Medical Equipment (DME). The first step for this process is to obtain a written prescription from your physician for this equipment.

Because of price differences some distributors or retailers only approve a less expensive model that may not meet your needs; however most manufacturers will assist you by providing sufficient documentation of the need for the more expensive model. With this documentation some insurance companies will approve this purchase. Others will only pay their share of the cost of a less expensive pump and allow the patient to pay all of the difference.

Although the insurance company agrees to the purchase of a lymphedema compression device it is not free because the patient is responsible for the co-pay portion which is usually 20% of the cost of the pump. In short, choose one wisely.

Note: If using a lymphedema compression device home unit consult with your lymphedema therapist as to the position of the leg(s) being treated, the pressure settings on the pump, and the suggested frequency and length of each treatment.

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Filed under: Leg lymphedema pumps