Vasopneumatic Compression Devices

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Chapter 48 Vasopneumatic Compression Devices

(Intermittent Compression Pumps)

OVERVIEW.

Vasopneumatic compression devices (VCD) are a form of compression therapy that uses mechanical force from a pump to intermittently exerts external pressure on a body part (i.e., increasing hydrostatic pressure, milking effects on fluid). The device typically includes a chambered sleeve wrapped around the involved limb, a connecting elastic tube, and an electric pump.¹

Vasopneumatic compression devices are used to treat lymphedema, reduce edema (due to venous insufficiency), help heal venous stasis ulcers (due to impaired circulation), prophylactically reduce the incidence of DVTs in postoperative patients, reshape residual limbs following amputation, and control hypertrophic scarring. Note: Because ICP can be applied at pressures that act as a tourniquet or induce fluid overload in some patients who have compromised cardiovascular systems, proper screening and monitoring are required.²

SUMMARY: CONTRAINDICATIONS AND PRECAUTIONS.

Five sources cited a total of 16 concerns for vasopneumatic compression devices. Concerns ranged from 2 to 16 per source, with a physical therapist citing the largest number. Most concerns were circulatory (about 45%). The most frequently cited concerns were deep vein thromboses, congestive heart failure, and severe peripheral artery disease.

Many of the reported compression device complications ³ (embolism-related deaths; palsies, pressure ulcers, compartment syndromes) stem from its use in DVT prophylaxis with surgical patients. In this protocol (compression lasts 12 seconds per minute, 40 mm Hg), calf compressions serve to reproduce leg contractions, promote venous return, and stimulate fibrinolysis for the prevention of thrombus formation.²

ADVERSE EVENTS

FOOD AND DRUG ADMINISTRATION REPORTS ³

Fatalities: Pneumatic Compression Pump: Maude and MDR (JOW)

Note: the majority of these devices had been used during and after surgery to prevent the development of deep vein thrombosis.

IPCD-Related Injuries

Date	Summary Outcomes
FDA, 11/12/97 to 6/29/04	During this 7-year period, the FDA has reported the following 24 nonlethal complications with IPCD: • 10 cases: skin ulcers, blisters, or redness • 5 cases: drop foot • 5 cases: pulmonary embolism (not deaths) • 1 case: stress fracture • 1 case: pedal edema due to incorrect application • 2 cases: unknown injury reported

Note: FDA reports do not necessarily establish cause-effect relationships between equipment and injury. Incidences may be due to equipment or user error. Also, some reports are alleged by attorneys.

REFERENCES

1 Cameron MH. Physical agents in rehabilitation: from research to practice. St. Louis: Saunders, 2003.

2 Lachmann EA, Rook JL, Tunkel R, et al. Complications associated with intermittent pneumatic compression. Arch Phys Med Rehabil. 1992;73(5):482-485.

3 U.S. Food and Drug Administration. Center for Device and Radiological Health [web page]. Available at: http://www.fda.gov/cdrh/mdr/. Accessed: November 7, 2005

4 Hecox B, Jacobs LF. External compression. In: Hecox B, Mehreteab TA, Weisberg J, editors. Integrating physical agents in rehabilitation. Upper Saddle River (NJ): Pearson Prentice Hall, 2006.

5 Hooker DN. Intermittent compression devices. In Prentice WE, editor: Therapeutic modalities for physical therapists, ed 2, New York: McGraw-Hill, 2002.

6 Grieveson S. Intermittent pneumatic compression pump settings for the optimum reduction of oedema. J Tissue Viability. 2003;13(3):98-110.

7 McGrory BJ, Burke DW. Peroneal nerve palsy following intermittent sequential pneumatic compression. Orthopaedics. 2000;23(10):1103-1105.