Intermittent Pneumatic Compression Therapy
Intermittent Pneumatic Compression Therapy
By Melanie McCann, Macmillan Lymphoedema Nurse, Herts Community Trust
This article is taken from the Autumn 2018 issue of LymphLine, the LSN’s quarterly newsletter available to all LSN members. For details of how to become a member, click here.
Intermittent pneumatic compression (IPC) therapy is a treatment that has been available since the 1930s. It has been used for conditions including lymphoedema, lipoedema, venous disease, leg ulcers, preventing deep vein thrombosis and managing arterial disease. Over time the IPC pumps have evolved with new technology and many pumps offer a wide variety of settings for people with different needs. All of this can make it difficult for patients to know if IPC might be a suitable treatment for them, how best to use it and what their outcome might be with this treatment. This article seeks to give an overview of this topic so users can make an informed choice about this treatment option.
What is IPC?
All IPC starts with the patient putting an inflatable garment onto their limb(s). The pump is a box that is powered by an electric supply to fill the garment with air to a pre-defined level of pressure. This then inflates and deflates in a regular fashion. The most common versions are those used on feet after surgery to prevent blood clots.
In the early versions of IPC pumps to treat lymphoedema and other conditions, the pumps inflated a single chamber garment to a set pressure and then relaxed. The pressure measurements were very dependent on the fit of the inflatable garment and the quality of the pump. More modern versions have multiple chambers and can vary the amount of pressure used and sequence of when the pressure goes on or is released to suit each condition. It is much safer to use the newer versions as this technology allows the machine to be calibrated and adjusted to suit individual needs and health.
The sequencing techniques of different machines also varies, some work down the limb, some up and some in ‘waves’ of pressure. Trying different pumps can help you decide what you can tolerate as well as what you find most effective.
How does it work?
The intention of using IPC is to improve lymph and venous return through the cyclical application of pressure and release in a similar fashion to Manual Lymphatic Drainage (MLD). Some therapists use the IPC to work on a limb whilst they work on the trunk. With lymphoedema, there is some evidence to suggest that pressures between 30-60mmHg are preferred for most patients, but pressures as low as 15-20mmHg might be used for those with more complex health needs and higher pressures of around 80mmHg are used in other countries. Applying too much pressure can close, rather than help, the lymphatics and repeated over time can damage the fragile initial lymphatics. A small study suggested repeated pressures of over 100mmHg have been shown to damage lymphatics. For this reason, more is certainly not always better!
It is thought that the sequential application of pressure and release helps return lymph into the deeper lymphatics, thus promoting more drainage. For those with venous disease, there is improvement in drainage of blood in the veins. With mild to moderate arterial disease, because of the intermittent use of low to medium pressures, IPC can actually improve the blood circulation as well as the oedema where other forms of compression might be difficult or unsafe to use.
Some pumps have inflatable garments that go below the knee, to the thigh, worn like trousers, or on the arm as a sleeve or worn as a jacket. For example, a person with foot and ankle swelling might only need a below knee inflatable boot, whereas someone treated for a gynaecological or prostate cancer, where there has been surgery and/or pelvic radiotherapy, may need a trouser style inflatable garment.
Always remember that the pump is ineffective above where the inflatable garment stops. One of the reasons they fell out of favour in the past was that people put them on the lower limbs and used them a lot, but did no self-massage and therefore swelling at the root of the limbs or genitals became a problem. For this reason, it is important to either perform self-massage or have someone else stimulate the lymph nodes above where the inflatable garments end. The more this can be done, the less likely root of limb swelling is to be a problem.
As there is an array of different conditions, pumps and inflatable garments, it is important that you take the time to think about your own condition, your ability to use IPC safely and what you might hope to gain out of treatment. From there you can work to understand which pump, inflatable garment and regime might suit you.
‘Many clinics will use IPC as a ‘second pair of hands’ during intensive treatments to allow you to get more value out of your treatment.’
How might IPC be used?
IPC can be used:
- As part of intensive treatment for lymphoedema
- As a daily treatment at home
- To help with tissue pain from lipoedema
- In addition to conventional treatment (compression garments and wraps)
- As an alternative to conventional treatments where there are limited other treatments, or lymphoedema services available to you.
Most regimes suggest using the pump for between 30-120 minutes a day, during which time the limb should be positioned at the same level as the heart to promote postural drainage.
If you have swelling that extends above the top of the pump’s inflatable garment, for example to the shoulder or genitals, there is a risk that this swelling can be made worse by using the pump. To minimise this risk, you should consider:
- Is this the right treatment for you?
- Is the pump garment the best option for you?
- Can you manage self-massage or have someone else perform Simple Lymphatic Drainage to the areas above the pump garment?
- Do you have a compression top or shorts that can be used simultaneously?
Are there contra-indications?
Absolute contra-indications include:
- Current infection.
- DVT or pulmonary emboli that has not been treated.
- If your body is not able to get rid of fluid effectively, this might be through heart failure, renal disease, pulmonary oedema or cancer-related obstructions. In these situations, it is more likely that the IPC will just be moving fluid from one area to another.
- If you have significant peripheral neuropathy (loss of sensation) then you might not notice pain or problems during treatment
What is the evidence on outcomes?
There have been several case reports and a few higher quality research trials on IPC. However, they all employ slightly different methods of use, durations and pressures, which is why there is no set programme for best practice at this time. In other patient groups, there was a belief that IPC would help wound healing and although there is evidence of improved blood flow, the outcomes on wound healing and arterial disease are less clear.
The outcomes patients commonly report are tissue softening, reduced tissue pain, that the limb feels smaller or there is better movement. Many clinics will use IPC as a ‘second pair of hands’ during intensive treatments to allow you to get more value out of your treatment.
The patient groups most likely to achieve an effect are those who are immobile and sit a lot, as the IPC is able to replace some of the benefits that movement would have provided.
The next group are patients who use IPC as an addition to their usual compression and exercise regimes. It should be noted that without ongoing compression through garments, bandaging or compression wraps, there is not likely to be a sustained beneficial effect to limbs from IPC alone.
It should also be noted that patients who have mild to moderate swelling with minimal tissue thickening are more likely to benefit than those with advanced tissue change.
How do I access IPC?
If you are under the care of a lymphoedema service, they may have an IPC system that you can try.
If you are not, some of the manufacturers offer trials at home for a month for a fixed fee, so that you can see if you feel IPC adds value to your care. If you do invest in one, with good maintenance, it may well last you for life.
As this article highlights, IPC has been around for a long time and many people have found it beneficial as part of their overall package of care. However, to use IPC to its best effect means spending time at the beginning understanding what type of machine and inflatable garment is best suited to you, based on your clinical needs and what might be realistic for you to gain from its use.
Where you do not have access to a lymphoedema service, you will need to ensure that you have a good understanding of your health needs and documentation from your GP or hospital consultant. It might then be worth contacting more than one company and speaking to their sales representative for these products so you can assess their strengths and limitations. Reputable companies are likely to ask for consent from a healthcare professional before they will sell you an IPC system to ensure that it is medically advisable.