by Guenter Klose
MLD/CDT Certified Instructor, CLT-LANA
Pneumatic Compression Devices (PCDs), a.k.a. “pumps,” have been utilized in the treatment of lymphedema since the early 1950’s. The initial devices used single-chamber pressure cuffs that applied a uniform level of compression to the entire limb. “New generation” PCDs use improved technology and are equipped with multiple chambers which provide calibrated, gradient-sequential inflation.
In the early 1990s, PCDs fell out of favor with practitioners after Complete Decongestive Therapy (CDT) was established as the standard of care for the treatment of lymphedema. Adverse effects were cited among some patients who used the device at unreasonably high pressure and some people were using PCDs without medical supervision. However, the benefits of a properly used modern-day PCD device may make it a valuable component of a home-care regime for select patients. The following will provide a new perspective on the question of whether a PCD may be a useful adjunct to the treatment of a lymphedema patient.
Initially, it is best to have the patient’s lymphedema condition assessed and treated by a Certified Lymphedema Therapist (CLT). The number of treatment visits will depend on the severity of a patient’s lymphedema. Once a maximum level of reduction is achieved, it may be beneficial to obtain a PCD to assist with in-home maintenance. This device will not eliminate the need for daytime compression garments, nightly bandaging, or any other items of self-care. Nevertheless, when used in conjunction with other daily self-care measures and weight loss (if indicated), a pump may lead to further limb volume reduction, improved range of motion, a decrease in subjective complaints such as heaviness and achiness, and ultimately, an improved quality of life.
Differenct Kinds of PCD’s
Most patients with lymphedema will benefit from a PCD which is equipped with multiple chambers that provide calibrated, gradient-sequential inflation. Since lymphedema often affects the adjacent trunk quadrant (chest and back in upper extremity lymphedema and buttock and groin region in lower extremity lymphedema), it is preferable to choose a PCD which includes a garment that also treats these core body areas such as with the Flexitouch model. If the patient’s lymphedema only involves the distal areas of the limb – and there is no reason to believe that proximal areas will become congested – a PCD which only covers the extremity may be sufficient.
Because every patient’s lymphedema and response to treatment is unique, there is no universal pressure setting that works for all. Also, there are no established guidelines for the optimal pressure value. A recent systematic literature review published in the Journal of Lymphology (2012) revealed that “A peak inflation pressure of 25-50 mmHg might be sufficient for most patients in the absence of significant fibrosis.” Personally, I recommend approx. 40 mmHg pressure for patients with upper extremity lymphedema and 50 mmHg for patients with lower extremity lymphedema, with an upper limit of 50 mmHg and 60 mmHg respectively.
Optimizing the Results
Treatment with a PCD should not be a passive measure. Patients will benefit from adding diaphragmatic breathing exercises and self-MLD. Self-MLD should be applied to areas of the body where the edema fluid can be processed by healthy lymphatics.
To ensure safe and effective treatment, patients using a pump must be advised to discontinue use of their PCD and contact their PCP and/or CLT if any of the following is observed: a new occurrence or increase in proximal swelling, swelling of the genital or breast regions, discomfort and pain in the affected limb, or redness and increased swelling with or without fever.
Please leave your comments and feedback below.
I have treated multiple pts and there were some pts that received pumps for home use and some that didn’t. I’ve seen successful reduction in both! I love my lymphedema pts!
I think the most important sentence in the above is: “device will not eliminate the need for daytime compression garments, nightly bandaging, or any other items of self-care”. We see so many referral for pumps, and both the patients and their physicians think that this is a magic cure-all and nothing more is required.
Additionally, I would stress that the patient needs medical review: for example, many patients have right and/or left heart failure; I have seen several patients thrown into congestive heart failure by indiscriminate use of the pump: the most recent was advised by his “wound care doctor” to use the pump (which he sold to the patient) for three hours on each lower extremity, while his ejection fraction was 12%.
Excellent explanation, it’s simple & focus