This document discusses intermittent pneumatic compression therapy (IPC), including what it is, the evidence for its use, and implications for amputee management. IPC uses compression pumps to intermittently inflate and deflate chambers around a limb to reduce edema. Studies show IPC can reduce edema in residual limbs, and may aid prosthetic fitting. IPC is also effective for lymphedema, deep vein thrombosis prophylaxis, and peripheral vascular disease. Proper dosage and combining with other compression is important to prevent rebound edema. IPC shows promise for improving amputee rehabilitation but more condition-specific research is still needed.

1. Intermittent Pneumatic
Compression Therapy
NSW PAR - 13th March 2009 - Blue Mountains
Craig Evans
Physiotherapist
Rankin Park Limb Centre
30/12/12
1

2. Current Edema Management Options
 RRDs
 Silicone liners
 Shrinkers
 Bandaging
 Prosthesis
 Intermittent Pneumatic Compression Therapy
(IPC)

4. What is IPC?
Variables:
 Constant
 Intermittent
 Sequential – number of chambers
 Duration , intensity (pressure) , Rx/rest phases

5. IPC Evidence - Settings
Author Type Duration (Mins) mmHg Inflation/Rx/Rest phases
Nikolovska (2002) ISPC 60, 5/7, 6 months 40-50 180s inflation time, 30s Rx, 60s rest
Coleridge-Smith (1989) ISPC 240, daily
Schuler (1996) ISPC 60am, 120pm 40-50 10s Rx, 60s rest (10mmHg)
McCulloch (1994) IPC 60, 2/7 50 90s Rx, 30s rest
Kumar (2002) IPC 60 x 2 daily, 4 months 60 90s inflation, 90s deflation
Rowland (2000) IPC ?S 60 x 2 daily, 2-3 months 50
Nikolovska (2005) - fast ISPC 60, daily, 30-45 0.5s inflation, 6s Rx, 12s deflation Vs.
Nikolovska (2005) - slow ISPC 60, daily, 30-45 60s inflation, 30s Rx, 90s deflation
Ginsberg (1999) IPC ?S 20, twice daily 50 ?
Kakkos (2000) ISPC ? 45 11s inflation, ?s Rx, 60s deflation
Lymphedema framework (2006) ISPC 30-120 30-60 nil recommended
Delis (2000) IPC >240 total per day 180 3s inflation, 17s deflation
Delis (2001) ISPC ? 120 4s inflation, 16s deflation
Chleboun (1995) IPC 20, daily, 5 days 60 40s inflation, 20s deflation

6. Evidence for use of IPC
 Wienert et al (2005) – Indications:
– DVT prophylaxis
– Post-phlebitic syndrome
– Venous edema
– Foot / Ankle ulcers
– Lymphedema
– Lipodema
– Peripheral arterial disease
– Diabetic foot
– Hemipeglia

7. IPC Evidence - Amputees
1 unobtainable Article!!!
Experiences in the use of a pneumatic stump shrinker.
Author: REDFORD JB
Journal: ICIB
Issue: 12(10), 1-6, 14
Year: 1973
Description: Describes methods used to reduce stump edema occurring after
amputation. Includes the Jobst intermittent compression unit which is applied to
reduce edema prior to casting the amputation stump for a temporary or permanent
socket. Rigid- plaster dressings have been used satisfactorily, as has Tensor
bandage wrapping and lycra tubigrip stump socks. Reduction of edema allows the
patient to be fitted with a permanent prosthesis in 40 to 60 days.
Inter-Clinic Information Bulletin (ICIB) was initiated in 1961 in the US to improve timely information sharing between
prosthetic and orthotic clinics for children. Now known as Clinical Prosthetics and Orthotics

8. IPC Evidence - Amputees
Anecdotally
 Reduces edema
 More effective on TTAs than TFAs
 ? Desensitization effect
 Used in other centres / states for over 30 years

9. IPC Evidence - Lymphedema
The Lymphedema Framework (2006)
 IPC recognised as an effective treatment
 Multi-chambered IPC > single chambered
 Other compressive therapy / garments to prevent
rebound

10. IPC Evidence – DVT Prophylaxis
 Kakkos / Nicolaides / Griffin / Geroulakos / Wolfe /
....collaboration
 “... is as effective as heparin” (Nicolaides et al 1980)
 Lacks hemorrhagic side effects of anticoagulants –
better option in trauma, brain injury (Kakkos et al,
2005)
 Potentially effective at preventing venous stasis and
therefore DVT (Kakkos et al, 2000)

11. IPC Evidence – PVD / wound management
Nelson Mani and Vowden (2008) Cochrane
Review – 7 RCTs on venous ulcers
 IPC may increase healing compared with no
compression.
 not clear whether it increases healing when
added to treatment with bandages
 Rapid IPC is better than slow IPC in 1 trial

12. IPC Evidence – PVD / wound management
Ginsberg et al (1999)
– IPC reduces symptoms of severe post-
phlebitis syndrome in ~ 80% clients who are
unable to tolerate pressure stockings
Delis et al (2000)
– IPC enhances collateral circulation ... “an
effective treatment in symptomatic PVD”
Delis et al (2001)
– Thigh IPC +/- calf IPC improves native arterial
and infra-inguinal bypass graft flow.

13. IPC - Contra indications
 Decompensating heart insufficiency (?CCF)
 Extensive thrombophlebitis, thrombus or
suspected thrombus
 Neuropathy
 Infectious disease (?infection)
 Acute soft tissue trauma to the extremities
 Occlusive lymphedema
(Wienert et al, 2005)

14. IPC - Contra indications
 Cancer?
 Increasing lymph and blood flow
 Lachmann et al (1992)
– peroneal neuropathy and lower leg
compartment syndrome following IPC for
surgical DVT prophylaxis.

15. IPC - Potential complications
 Peroneal nerve palsy/neurovascular
compression
 Ischaemia
 Compartment syndrome
 PE
 Genital lymphedema
(Wienert et al, 2005)

16. So what do we use?
 ISPC
 Multi chambered unit
 Preset cycles (28:11)
 45-60 mmHg
 Up to 30 mins
 1 week to 2-3 months post op
 Infection control procedures

17. Measuring improvement / volume
reduction
 Tape
 Fit of prosthesis / RRD
Other:
 CAD CAM digitizer / scanner
 Serial Casting
 Archimedes principle
 Doppler / Duplex / ABPI (ankle brachial pressure
index)/ tcPO2

18. Implications for Amputee Management
 No empirical residual limb evidence
 Physiological evidence – potential residual and intact limb
benefit
 Useful where other Rx strategies are not tolerated well.
 Dosage rationale / evidence
– “rapid” IPC is better than “slow”
– determined by in built machine settings.
 IPC + other compression modalities to prevent rebound
edema
 Anecdotally effective
 There is plenty of scope for producing better quality amputee
related evidence!

19. References
 Ginsberg, Magier, Mackinnon and Gent (1999). “Intermittent compression units for severe post-phlebitic
syndrome: a randomised crossover study.” CMAJ, May, 160(9), 1303-1306.
 Nelson EA, Mani R, Vowden K. Intermittent pneumatic compression for treating venous leg ulcers. Cochrane
Database of Systematic Reviews 2008, Issue 2. Art. No.: CD001899. DOI: 10.1002/14651858.CD001899.pub2.
 Gilbart, Oglivie-Harris, Broadhurst and Clarfield (1995). “Anterior tibial compartment pressures during
intermittent sequential pneumatic compression therapy.” American Journal of Sports Medicine, 23(6): 769-772
 Engstrom, B., Van de Ven, C.. (1999). “Therapy for Amputees” (3rd Edition) Churchill Livingstone.
 Kakkos, Griffin, Geroulakos and Nicolaides (2005). “The efficacy of a new portable sequential compression
device (SCD Express) in preventing venous stasis.” Journal of Vascular Surgery, 42(2): 296-303.
 Kakkos, Szendro, Griffin, Daskalopoulou and Nicolaides (2000). “The efficacy of the new SCD Response
Compression System in the prevention of venous stasis.” Journal of Vascular Surgery, 32(5): 932-40.
 Delis, Nicolaides, Wolfe and Stansby (2000). “ Improving walking ability and ankle brachial indicies in
symptomatic peripheral vascular disease with intermittent pneumatic foot compression: a prospective controlled
study with one-year follow-up.” Journal of Vascular Surgery, 31(4): 650-661.
 Delis, Husmann, Cheshire and Nicolaides (2001). “Effects of intermittent pneumatic compression of the calf and
thigh on arterial calf inflow: a study of normals, claudicants and grafted arteriopaths.” Surgery, 129(2): 188-95
Feb (abstract only)
 Nicolaides, Fernandes, Fernandes and Pollock (1980). Intermittent sequential pneumatic compression of the
legs in the prevention of venous stasis and postoperative deep venous thrombosis.” Surgery, 87(1): 69-76, Jan.
(Abstract only)
 Wienert, Partsch, Gallenkemper, Gerlach, Junger, Marschall and Rabe (2005). “Guideline: Intermittent
pneumatic compression.” Phlebologie, 34(3): 176-80 (German)
 Lachmann, Rook, Tunkel and Nagler (1992). “Complications associated with intermittent pneumatic
compression.” Archives of Physical Medicine and Rehabilitation, 75(5): 482-5. (Abstract only)
 Lymphedema Framework (2006) . Best Practice for the Management of Lymphedema. International consensus.
London: MEP Ltd.