Clinical

Structure and function of the Lymphatic System

Huntleigh are committed to providing information to support each of its solutions. In this section, patient information and abstracts of clinical papers relating to the use of compression systems are available.

The lymphatic system is considered the third element of your cardiovascular system. It is made up of organs and lymphatic tissue:

  • Spleen and thymus
  • Lymphatic capillaries, vessels and nodes

  • The combination of these items helps achieve the functions of the lymphatic system which are:

  • Draining of the interstitial fluid
  • Fighting infection
  • Transportation of lipids


The use of Intermittent Pneumatic Compression (IPC) in the management of lymphatic disorders

Lymphoedema (primary and secondary) is a condition resulting from the disruption to the patient’s lymphatic system. Protein rich fluid accumulates in the soft tissue and affects parts of the body such as arms, hands, neck, trunk and legs.

Although pneumatic compression systems have been used in the management of “swelling” since the 1950’s, recent developments resulting from technological advancements have allowed manufacturers to develop advanced systems which replicate manual massaging – as in the case with LymphAssist®.

 

Literature Reviews

 

Intermittent Pneumatic Compression Therapy: A Systematic Review
J.L. Feldman et al. Lymphology 45 (2012) 13-25

Objectives: A systematic review of contemporary peer reviewed literature (2004 – 2011) to evaluate the evidence for the use of IPC in the treatment of Lymphoedema
Outcomes: In selected patients, IPC may provide an acceptable home based treatment modality in addition to wearing compression garments.
IPC is well tolerated in low to moderate pressure ranges and the device enables compression application in the patient’s home.
IPC is a safe and effective intervention for many suffering with chronic Lymphoedema
Individualised multi modal approach is optimal to treat Lymphoedema and evidence shows that IPC devices may play a formative role in this approach.

 

Redefining essential Care in Lymphoedema: A Clinical Focus
Wigg, J. Lee, N. Chronic Oedema October 2013

Objectives: A discussion about the process and alternative essential treatment options available in order to increase clinician’s awareness and to encourage critical thinking and discussion making in the management of Lymphoedema.

Outcomes: New machines such as the Hydroven 12 with the unique LymphAssist cycle can be used instead of MLD
Modern IPC can reduce limb volume, soften tissue, and re-establish lymphatic pathways with no evidence of causing genital oedema and working in the same way as MLD.
The LymphAssist cycle is based on the LUDEC method of MLD sequence and will reduce fibrosed tissues
Intermittent Pneumatic Compression is used as a mainline treatment in the USA and is cited as routine care within the ISL consensus document (2013).

 

Intermittent Pneumatic Compression acts synergistically with manual lymphatic drainage in complex decongestive physiotherapy for breast cancer treatment related Lymphoedema
Szolnoky, G., Lakatos, B., Keskeny, T., Varga, E., Varga, M., Dobozy, A., Kemeny, L. Lymphology 42 (2009), 188-194

Objectives: Investigate whether the combination of IPC with MLD could improve CDP treatment outcomes in women with secondary Lymphoedema after breast cancer treatment.

Outcomes: MLD alone or in conjunction with IPC as part of a CPD protocol resulted in a reduction in arm Lymphoedema and subjective complaints.
Treatment with IPC pumps added a significant volume decrease.
During application and in post treatment follow up, side effects such as swelling in the ipsilateral body quadrant or pain were not observed.

 

Position Statement of the National Lymphoedema Network

February 2011

 

  • Effective treatment for Lymphoedema is available.
  • Early diagnosis is important since treatment is most effective when Lymphoedema is diagnosed at the easiest possible stage.
  • Every patient with Lymphoedema should have access to established treatment for this condition.
  • IPC can be useful in some patients as an adjunct to phase 1 CDT or a necessary component of a successful home programme (phase 2).
  • Single chamber pumps as used in the past are not now used for Lymphoedema – single chamber garments can cause fluid to move in either direction, meaning that fluid can build up in already swollen areas.
  • Recommended garment pressures range from 30-60mmHg, although lower or higher pressures may be indicated
  • Patients being considered for IPC must be assessed by a specialist in Lymphoedema.

  • The prescription must include the intensity of the pressure and the particular pressure pattern
    needed taking into consideration several aspects of the patient’s condition.


    SUMMARY

    Evidence to date highlights the known benefits of IPC; it is safe, non-invasive, comfortable, can be applied by users or their care givers and often offers significant cost savings. (Vowden 2001).

    When applied to lymphatic management, Hydroven intermittent pneumatic compression is a cost effective modality which has the potential to prevent or attenuate these disease processes.

    “….Modern IPC can reduce limb volume, soften tissue and 
re-establish lyphatic pathways with no evidence of causing genital oedema and working in the same way as MLD”
    Wigg 2013


         

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