Pumps

What is the importance of gradient?

Sequential pumps with calibrated gradient pressure have proven to be the best devices for reducing the amount of excess lymphatic fluid in a limb in a comfortable and efficient manner. These pumps function in much the same manner as the body does when it utilizes its own “muscle pump.” The body uses various muscle groups to move the lymphatic fluid through the channels.

How do I set the pressure on the pump?
Suggested protocols have been provided with your pump. Follow these suggestions unless otherwise directed by your physician or therapist. Never increase the pressure unless told to do so by your physician or therapist. Should you reach a plateau in your treatment and feel as though you are not achieving further reduction, decrease the pressure and monitor your progress. It is possible that you may be using too much pressure.

How long do I use the pump?
The suggested protocols provided with your pump are designed to help you gain the maximum benefit from your therapy.  Again, you should follow these instructions unless otherwise directed by your physician or therapist. In some severe cases, the physician and/or therapist may deviate from the provided protocols based on your condition.

What is the application of the pump for treating ulcers and open wounds?
The pump can be used on patients with venous ulcers and/or open wounds as long as there are no signs of an untreated infection/cellulitis. If you have cellulitis you can use the pump once antibiotics have been administered for at least 72 hours. Signs and symptoms for infection are an abnormal sensation of heat in extremity, a rash, red streaks, pain or fever. If one or more of these symptoms occur while you are under compression therapy treatment, discontinue your treatment and contact your physician. Wounds must be covered with the appropriate dressings and it is recommended that daily dressing changes be ordered. You should clean and change your dressing immediately following your treatment with the pump. Wounds will drain significantly during pump therapy; this is normal.

How are compression garments used in treating lymphedema?
Compression garments are specially designed to maintain and support the limb, not to reduce its size. Garments must be applied in the morning to prevent gravity from pulling fluid down into the limb. If this happens the garment will trap the fluid and will not fit comfortably.

The patient should use rubber gloves to help in the application of the garment, as these will reduce slipping and make application easier. Garments should be worn daily and removed at night.

Compression garments are available in standard and custom styles. There are several companies to choose from, with the final choice usually coming down to cosmetics and cost. Garments usually last about 6 months; after that, the patient should be re-fitted. The patient should be re-measured each time a new garment is ordered, to account for any changes in the size of the limb (larger or smaller). Compression garments are machine-washable but seem to last longer when hand-washed. The patient will know it is time to get re-fitted when they notice that their limb tends to swell slightly at the end of the day or they notice any signs of stretching in the garment fabric.

Recent Medicare rulings require that this type of therapy (custom garments not mandatory) be tried for 30 days and that a doctor determines it to be ineffective before pump therapy will be approved for use. This is in contrast to the former regulation, which listed pump therapy as a last resort.

How does bandaging or wrapping control lymphedema?
The practice of bandaging and wrapping is a more recent innovation in the U.S., although it has been used in Europe for quite some time. This treatment utilizes a four-layer wrap that works in conjunction with a pump and compression garments to control edema. All the digits (fingers and toes) are wrapped individually. The hand or foot is then wrapped, followed by the forearm/calf, elbow/knee, upper arm, and thigh. This type of therapy can be taught to some patients, but older patients or those with limited dexterity (e.g., arthritis) may have difficulty applying the wrappings themselves. The bandages are reusable. This is important because the bandages are not stocked by every medical supply company and are expensive. Those patients who are able can wrap their limb at night, and in the morning take off the wrap and put on their compression garment.

How important is hygiene for lymphedema patients?
The patient must be taught meticulous skincare, especially with the edematous limb. Because of the increased fluid levels under the skin, the skin is much more susceptible to rips and tears than is non-edematous skin. Any breakdown in the integrity of the skin results in susceptibility to bacteria, infection, and cellulitis, the most serious of complications facing the patient. Teach the patient to treat all cuts, burns and bruises, hangnails, ingrown toenails, ingrown hairs, razor rashes, blisters, scrapes, mosquito bites, etc., as potential sites for infection.

Should the patient notice any signs or symptoms of infection or cellulitis they should contact their doctor immediately. Delay in treatment will enable the infection to spread to other areas throughout the body.