Intermittent pneumatic compression treatment (IPC)

Figure 1 Intermittent pneumatic compression consists of an inflatable compression cuff with many chambers in many sizes and lengths.  Some are meant for just the leg, and some are thigh-high. The compression garment is attached to an electrical pneumatic pump which inflates the chambers in a sequential pattern.

( Note IPC is also an abbreviation for Infection Prevention and Control, a WHO program in many African regions.  In this chapter, IPC, however, stands for intermittent pneumatic compression)

 

 IPC is a powerful treatment modality used in cases with severe edema, such as lymphoedema. However, many patients with venous ulcers or severe venous insufficiency will also benefit from the treatment.  All too few wound care providers and patients are aware of this treatment, which is relatively easy to use. In western countries, patients often use this treatment at home.  Note that this is not a substitute for other compression treatments with bandages or stockings.  IPC is a supplement to the regular compression the patient is already using!  Any patient with chronic edema will benefit from such a pump ( in an ideal world, every patient with chronic limb edema should have such a pump), but obviously, there is a price tag attached to this treatment.

If you wonder how IPC works think of it as an automatic machine massaging the extremity from distal to proximal many times during treatment ( 1-2 hours). The chambers inflate in a sequential pattern from distally to proximal - milking fluids in the tissues towards the heart.

IPC may also be a solution in cases where the patient cannot use regular compression garments because the edema is so extreme.  In these cases, IPC can be used to decrease the edema such that, for example, compression stockings can eventually be fitted. Between the IPC treatments, these patients have to use compression bandages until they can switch over to stockings or other devices. 

 

Before treatment commences, the right size of the compression cuff has to be measured  ( circumference above ankle, biggest circumference of leg and thigh, and length from base of toes to the groin level). In western countries, this is usually done in specialist centers or by physiotherapists with special training in this treatment. If you work in Africa and have access to such a machine, you will likely have to make the sizing measurements yourself. Possibly you only have one cuff, which has to be shared among several patients, and you may have to make compromises in sizing then.  These cuff sizes are quite forgiving.  Even a too-large cuff will fit quite well.  On the other hand, a too-small cuff will not work- either you won't even manage to get it on, or the cuff will loosen as it is inflated.  So again-  a too big cuff is better than a too-small cuff.   Ideally, each patient should have their own cuff for hygienic reasons - in a setting with limited resources; you may have to work around this requirement by thoroughly disinfecting the cuffs between patients.

IPC treatment is available at some centers/hospitals in Africa but only for a select few patients. Actually, it is a simple technology, and while the major producers have more expensive models, it can be obtained cheaply from other sources. Whenever we at woundsafrica.com want to know what medical items really cost, we go to our reference point alibaba.com. Here we found many IPC units as cheap as around 100 US Dollars!  This may even be within financial reach for some patients in Africa to have such a pump at home for daily use.

Here we have another business tip for someone looking for a work niche or a career change. Start an IPC daycare center with five or more pumps available where patients can come 1-2 times a week for a few hours of treatment. Lymphoedema and other forms of edema are common in Africa, and there is a demand for this type of service as long as it is not too costly.  Your main challenge will be the cuffs. Ideally, each patient should have their own cuffs for hygienic reasons, as we mentioned above. This will be too costly in most settings in Africa, and you will have to disinfect the cuffs between each patient thoroughly.  Also, you should have solid training in general compression treatment ( compression bandages, compression stockings) as these questions will arise if you provide a service with IPC treatment. 

Note that you cannot simply start a patient on IPC treatment. IPC is a powerful treatment that can mobilize large amounts of fluids in a few hours - it can be a dangerous treatment if used incorrectly.  If there is severe edema in the extremities, the IPC treatment can force the fluid from the extremities into the blood system, causing an overload of the heart and even lung edema. These conditions can be fatal.  Therefore, IPC treatment must be started very carefully - for example, just an hour at low compression at the start.  Later on, once the extremities are getting less swollen, the intensity and length of treatment can be intensified.  Ideally, the patient should use the pump twice daily for the best effect ( not at the start, obviously but later on in the treatment).

 

We usually admit the patient to a hospital ward to start the treatment in our practice. That is to monitor the patient closely for adverse effects like signs of heart failure or overload of the lungs during the treatment. Note that patients with existing heart conditions may have to get diuretic medication to aid in fluid removal at the start of the treatment. So IPC treatment is not something that should be taken lightly - it is, as we stated above- a powerful and highly effective modality, but it can have serious side effects if not used correctly. However, it is considered a safe procedure if you start the treatment carefully and gradually increase the intensity over several weeks. 

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Figure 2 IPC units and cuffs come in many price ranges from 1000 US Dollars and upwards. WoundsAfrica uses alibaba.com as a reference point for the cheapest available products, and here we found units starting at about 100 US Dollars.  IPC treatment can therefore be a realistic option also for many African patients.