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Nordsjællands Hospital-Hillerød Department of Orthopedics 2013

COMPLICATIONS ASSOCIATED WITH COMPRESSION AND INTERMITTENT COMPRESSION THERAPY (IPC)!

Md. Jonas Hedegaard Andersen!Md. Mikkel Sundstrup!Wound Care Nurse Nina Baekmark!

Poster : EP447

Orthopedic Department!

Hillerød!

Compression Therapy

Intermittent Pneumatic Compression (IPC)

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Theory!Compression and IPC has become an integral part of medical therapy in more than one aspect.!Both IPC and compressions role in prevention of Thrombosis have been proven1-2.!Compression and IPC have become an important part of ulcer manegment3-5 In addition to this there has been some evidence that IPC has a role in fracture manegment6!From the prevailing evidence and our own experiences with compression and IPC, the two modalities have become every day tools in our orthopedic department. !Compression and IPC is used every day in the management of wounds, fractures, compartment syndrome, etc.!To our knowledge there hasn't, to this date, been any documentation of the incidence of compression damages.!The aim of this poster was to register the number of IPC and compression treatments delivered, and the number of adverse effects in a three month period at our department!

Method!Prior to the registration period, personnel in our Department, including operation ward, out patient clinic and bed wards, were informed verbally and by E-mail, about the project.!Handouts with coding for treatment with compression and IPC, along with an e-mail address for the registration of adverse effects, were handed out at the departments. !After the three month period the codes were drawn from our registration system and analyzed, along with all the reported adverse effects!

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Results!In the three month period a total of 443 compression and IPC treatments were delivered. In the same period 3 adverse effects were registered. This correlates to a incidence of adverse effects of 0.7%!If the treatments are broken down into one group compromising compression stockings and bandages and one group with IPC the incidence of adverse effects is 0.8 % and 0 % respectively for bandages/stockings and IPC. (se tab.1)!Of the adverse effects 2 can be classified as grade 1, and 1 as grade 2 according to the NPUAP-classification7(se tab.2)!

Treatment No. Treatments

No. Adverse Events

Incidens in %

Compression Bandages/

Stocking

386 3 0.8 %

IPC 57 0 0 %

Total 443 3 0.7 % Tabel. 1

Grade 1 Grade 2 Grade 3 Grade 4

No. of events 2 1 Tabel. 2 Grades as described by NPUAP-classification7

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Discussion!This poster documents that there are relatively few adverse effects linked to compression and IPC treatment (<1 %).!And that most of the adverse effects are of a low grade. These results are from a department were compression is an integral part of our treatments of a wide verity of ailments. We probably use compression more than most departments, and at the same time there has been a focus on teaching application of compression, and the theory of compression. Therefore our department is probably not a average department when it comes to the use of compression therapy. !In our opinion every department that utilizes compression, should have focus on teaching application and therapy compression. By teaching these two points, every department can, in our opinion, reach similar results. !It should be noted that two of the three adverse effects reported was in relation to treatment with compression bandages of edema in relation to externally fixated fractures of the lower limb. This is not a normal treatment modality, but has been developed and implemented at our department over recent years.!

Future Perspective!The registration was most likely not complete in this observation period. This will be rectified in later observation periods, by better information both electronically, in paper form and verbally!In the next observation period compression bandages and stockings will receive separate codes!

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1: ”Stratified meta-analysis of intermittent pneumatic compression of the lower limbs to prevent venous thromboembolism in hospitalized patients.” Ho KM1, Tan JA. Circulation. 2013 Aug 2: ”Elastic compression stockings for prevention of deep vein thrombosis” Sachdeva A1, Dalton M, Amaragiri SV, Lees T. Cochrane Database Syst Rev. 2010 Jul 3: ”Compression for venous leg ulcers” O'Meara S1, Cullum N, Nelson EA, Dumville JC. Cochrane Database Syst Rev. 2012 Nov 4: ”Compression for preventing recurrence of venous ulcers.” Nelson EA1, Bell-Syer SE. Cochrane Database Syst Rev. 2012 Aug 5:”Intermittent pneumatic compression for treating venous leg ulcers.” Nelson EA1, Mani R, Thomas K, Vowden K. Cochrane Database Syst Rev. 2011 Feb 6: ”Intermittent pneumatic compression in fracture and soft-tissue injuries healing” Khanna A1, Gougoulias N, Maffulli N. Br Med Bull. 2008 7: http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?productid=1492&pageaction=displayproduct