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Thursday, September 17, 2009

Lymphedema Compression Pumps

Put a crowd of lymphedema patients, therapists and doctors together and nothing will start a heated debate like the topic of using pneumatic compression pumps for the treatment of lymphedema.

Compression pumps were at one time a standard of treatment for
lymphedema. These older types referred to simply as compression pumps consist of an inflatable garment for the arm, leg, or foot and an electrical pneumatic pump that fills the garment with compressed air. The garment is intermittently inflated and deflated with cycle times and pressures that vary between devices. These antiquated devices have been replaced by intermittent/ sequential pumps which consist of numerous chambers that inflate one at a time while moving up the arm or leg. Due to complications such as genital lymphedema and possible further damage to existing superficial lymphatics, many patients and medical professionals are no longer in favor of using compression pumps to treat lymphedema.

Time for a new dialogue and re-evaluation?

Today, however, there is a new generation of compression devices coming in to the market that offer the possibilities of a safe and effective addition to our treatment arsenal.

My hat is off to two companies in this regard.

First, Tactile Systems for their Flexitouch Device and BioCompression for its development of pneumatic compression therapy that uses the Reid Sleeve Optiflow insert which has been demonstrated to not damage the superficial lymphatics.

Factors for Consideration in Using a Compression Pump

The question about compression pumps is not whether they are effective in the movement of fluid. This has been clearly demonstrated and without a doubt they are extremely effective. The central problems are the possible complications. The clinically demonstrated complications as mentioned above are (1) genital lymphedema because devices have not cleared the abdominal lymphatics before use of the pump and (2) damage to the superficial lymphatics. It is also my personal opinion that the use of pneumatic compression devices must not be marketed as a replacement for manual decongestive therapy by a certified lymphedema therapist or for a substitution in the use of compression bandaging… Rather, it should be used as adjunct for maintenance and should be included in the overall patient self-care program.

It is also important to understand the difference between treatment for arm lymphedema versus leg lymphedema. It is my utmost desire to provide important and independent information for patients as they decide whether or not to use a compression device.

Compression Pumps for Arm Lymphedema

It has been substantially demonstrated through various studies that the best treatment for
arm lymphedema is actually a combination of manual decongestive therapy, compression bandages and the use of a compression pump.

In my personal opinion, I have no problem recommending this treatment modality.

Compression Pumps for Leg Lymphedema

The complications listed above have centered around the use of compression pumps for the leg lymphedema. Hopefully, the two new devices manufactured by Tactile and by BioCompression will resolve these issues.

Those of us with leg lymphedema desperately need some time of additional
treatment option that not only helps but that we can feel totally safe using.

Contraindications for the use of a compression pump

A compression pump should not be used if:

You have an active infection
You have a blood clot or deep venous thrombosis
You have kidney or renal failure
You have congestive heart failure
You have body-wide edema
You have
plueral effusions (lung fluid)
You have episodes of pulmonary embolism
You have

Should I use a Sequential Pump?

Opinion Article - From a Certified Lymphedema Treatment Therapist

While there have been clinicians, therapists, and patients who have not had good results with pumps and do not recommend their use, hundreds of people have experienced great results with the proper use of the right pumps. Pumps are not for everyone, and success does depend on which pump is used, and the proper application of pumps. Pumps, like prescription drugs, or even like driving a car, if not used properly can cause damage, or will not achieve results. In providing lymphedema therapy for thirteen years, helping hundreds of people, I have never seen some of the problems some people are reporting. Many of the people I have worked with have successfully used their pump for five to ten years with no complications.


Some therapists may tell you that pumps are a waste of money, that they do not work, that they do not help in opening up lymphatic flow, or that pumps make edema worse. Only part of this is true. When any clinician gives you information on clinical treatment, ask to see scientific clinic studies. Many “opinions” have been published, but no scientific clinical studies have been conducted or published that will back up these statements. There are however, many many scientific, clinical, published studies that prove the efficacy of pumps. Pumps also do not assist in opening up the lymphatics, nor were they designed to, nor are the recommended as such. Pumps are to be used as an alternative for bandaging, and MLD is applied to open up the lymphatic system. It is not appropriate for any clinician or patient to deprive you of any treatment that may really help you, by providing you with misinformation. If your disease is not properly treated and managed, serious health complications can occur. If a pump will assist you in accomplishing effective disease management, and your are given misinformation regarding their effectiveness, this is call for serious concern. Pumps have been clinically proven, beyond opinion, to help hundreds of thousands of people worldwide, but it is important to make sure you are a candidate, make sure you use the right pump, and make sure you use your pump correctly. It is not complicated, and I will review pump information below.

When reviewing pumps, look for a pump that contains ten or more chambers, operates on a short thirty-second cycle time, and applies graduated compression. The body operates on a pressure gradient system, so it is essential to obtain a gradient or graduated compression pump. Gradient or graduated means the pressure at the feet or hand is greater than the thigh or shoulder. Pressure starts at 60mmHg, and is about 1.5% less each chamber as compression moves proximal or towards the thigh or shoulder. Pumps that contain more chambers, and operate on a thirty second cycle versus sixty second cycle more closely mimics massage, and do not over compress the superficial lymphatics. Pumps that are not gradient, operate on a sixty second cycle and contain less than ten chambers can cause a reflux of fluid in the distal veins, and damage the superficial lymphatics. This has been proven upon review of pump compression during Doppler Ultrasonography. The result of this is pain, and edema that does not reduce but actually gets worse. Also, pressures should not be set higher than 60mmHg.

Doppler Ultrasonography shows that when external pressures are applied above 60mmHg, venous flow decreases rather than increases. The goal is to increase venous return in order to remove excess edema causing fluid. When venous return decreases, so does lymphatic flow.

Unless you have no other alternative, do not accept a pump from a supplier who is going to ship it to you or drop it off at your door step. Pumps should be set up in your home, and the provider should properly educate you on the proper use of the pump. If your health insurance company requires you to use an in-network provider who will not provide home set-up, have your physician include “home-set-up and patient education”, in his written prescription for your pump.

Pumps should not be applied over compression bandaging or compression stockings. They should be applied for about two hours in the morning, and two hours at night during treatment, and then as needed for continued edema reduction. Pumps should not be used during sleep over night, unless you are hospitalized, and your physician is directly monitoring treatment. I recommend the use of a Reid Optiflow, Jovi-Pak or Tribute for use with sequential pumps. These foam compression binders can be very effective in protecting the superficial lymphatics, and assisting the direction of lymphatic flow. Manual lymph drainage should also be applied either before and after pump therapy, or during pump therapy. If you have genital edema, or edema in the hips waist and abdomen, the LymphaPress pump has a bodysuit appliance that applies compression from the feet to the chest area. This has assisted my patients in significant abdominal reduction of edema.

You should not use a pump if you have
edema throughout your entire body, if you have a blood clot, if you have an active infection, if you have (kidney)renal failure, if you have active cancer, if you have congestive heart failure, or if you are not applying manual lymph drainage. Pumps are also not normally recommended for babies, or children under age six.

For further study, information and lists of manufacturers please see:

Compression Pumps for Lymphedema Treatment

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