Understanding Lymphedema Pumps

INTRODUCTION

The goal of using a pump in the treatment of lymphedema is to move excess fluid out of the affected limb and return it to the cardiovascular system. A pump is used by some treatment facilities as part of a professional service. An even more important role of the pump is for use at home by a patient who has been trained in its proper use.

If the pump is not used properly, it can force excess fluids into the surrounding tissues, therefore creating more problems.  

THE TWO PHASES OF PUMP TREATMENT

No matter what the treatment setting, there are two phases to each pump treatment. These are the preparatory and drainage phases.

#1. THE PREPARATORY PHASE

The preparatory phase, which must be performed first, is Manual Lymph Drainage to prepare the lymphatic vessels to receive the fluid that will be moved by the drainage action of a pumping. When the preparatory phase is not completed properly, the lymphatic system is not ready to receive and transport the lymph that is moved by the pump. When this happens, the lymph is forced into the surrounding tissues where it can cause additional damage.

In a professional setting, a professional lymphedema therapist prepares the patient by performing manual lymph drainage (MLD). This stimulates the lymphatic vessels in preparation for receiving the flow of lymph created by the pump.

In a home setting, the preparatory phase is performed by the patient as self-massage, or by a caregiver as Simple Lymph Drainage (SLD). This preparation must be carefully completed to prevent any damage to the tissues.

#2 THE DRAINAGE PHASE

In the drainage phase, the pump settings are adjusted to the appropriate pressure level before the garment is donned. Then the pump is activated for the appropriate period of time while the patient rests comfortably with the affected limb in the recommended position.

The movement of the pump stimulates the flow of the excess lymph out of the affected limb as if were flowing following the movements of the muscles. When the lymphatic system has been properly prepared, this fluid will flow into the lymphatic vessels and eventually be returned to the bloodstream.

AFTER A PUMP SESSION

After a session on the pump is finished there are still two more step to be completed:

First: Remove the pump garment and perform a brief M-L-D session on yourself by working from the end of the treated limb upward toward the terminus to help the released fluid return to the cardiovascular system.

Second: Put on a compression garment. If you use the pump in the evening, put on your night compression garment. If you use the pump during the day, put on the knit compression garment that you wear when you are active.

Unless you complete these steps. the fluid released by the pump will flow back into the tissues instead of draining properly as it returns to the circulatory system. Therefore unless you don a compression garment, the tissues will soon be swollen again.

TWO TYPES OF PUMPS

There are currently two types of pumps that are widely accepted for the treatment of lymphedema. A major difference in these types of pumps is the way in which the preparatory phase is managed.

SEQUENTIAL GRADIANT PUMP

Sequential Gradient pump (Courtesy of Lympha-Press.)

The Sequential Gradient Pump, such as the one shown here which is treating the patient's leg, is an automated pump that pushes air into channels built into the garment worn by the patient. When in use, the controls of the pump cause the garment to inflate and release in gentle sequential movements that imitates the natural flow of lymph from the distal end of the limb (hand or foot) toward the trunk of the body.

With this pump style, the "preparatory phase" is performed manually either by the patient or lymphedema therapist before the garment is donned.

Before using the pump for the first time, consult with your lymphedema therapist as to the position of the limb being treated, the pressure settings on the pump, and the suggested frequency and length of each treatment.

THE FLEXI TOUCH PUMP

The FlexiTouch Pump, such as the one shown below is treating the patient's arm, differs from other pumps in that it automatically completes both treatment phases. When you receive your pump the settings should be adjusted for both the preparatory phase and the treatment phase including the proper pressure and length of treatment.

The garment is carefully donned and the patient assumes the recommended position before the system is turned on. After the system has completed the preparatory phase it will automatically moves into the drainage phase. It is important that both phases by completed at one time. This takes about an hour each day.

Flexitouch Pump. Photo courtesy of Tactile Systems

HOW TO USE A PUMP

Before the pump can be used it requires settings of the controls and garments. These are different for each patient and should be based on the recommendation of the patient’s therapist. Receiving a box on your doorstep is not adequate service unless the machine has been customized to your needs before it was shipped.

• Even after the setting has been established, the patient must learn to use don the garments and use the pump. It may also be necessary to have assistance in this process.
• Once the pump is in use it may be necessary to change some of the settings and it is important to know how to make these changes.

PURCHASING A PUMP

Since the pump is used at home it is necessary that the patient purchase this piece of equipment. Before making this investment, it is recommended that you investigate the pump carefully to be certain that it will work for you. You must also determine that you will follow through the daily routine of using it.

The patient must be motivated to use the pump regularly and in accordance with the instructions for its use. As with other lymphedema treatment plans, without patient compliance the treatment cannot be successful in controlling the swelling of lymphedema.

INSURANCE COVERAGE FOR PUMPS

A pump is a major expense; however most insurance plans, including Medicare, will approve the purchase of a pump as Durable Medical Equipment (DME). The first step for this process is to obtain a written prescription from your physician for this equipment.

Because of price differentials, some carriers only approve a less expensive model that may not meet your needs; however most manufacturers will assist you by providing sufficient documentation of the need for the more expensive model. With this documentation, some insurance companies will approve this purchase. Others will only pay their share of the cost of a less expensive pump and allow the patient to pay all of the difference.

Although the insurance company agrees to the purchase, the pump is not free because the patient is responsible for the co-pay portion which is usually 20% of the cost of the pump.

CONCLUSION

The appropriate use of a lymphedema pump is the solution to a major problem for many lymphedema patients. It is particularly important for those patients who do not have access to professional care because of distance, financial problems, transportation hurdles, or other obstacles.

The keys to success in using a lymphedema pump are: (A) It must be used daily as instructed and (B) It must be used for the recommend length of time.

REFERENCES

1.  "Home-Based Lymphedema Treatment in Patients With, and Without, Cancer Related Lymphedema" by S.H. Ridner, RN, Ph, E McMahon, PhD. M.S. Dietrich PhD., and S. Hoy, Esq. Oncology ursing Forum, 35(4):671-680, 2008.
2. "Living Well with Lymphedema" by Ann Ehrlich, Alma Harrewijn PT, CLT-LANA, and Elizabeth McMahon PhD. Lymph Notes, 2005.
3. "Influence of Compression Cycle Time and Number of Sleeve Chambers on Upper Extremity Lymhedema Volume Reduction During Intermittent Pneumatic Compression" by U. Pilch, M. Wozniewski, A Szuba. Lymphology 42 42 (2009) page 26-35.

© LymphNotes.com 2014. This information does not replace the advice of a qualified healthcare professional.

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Category: How Lymphedema is Treated Updated: 2014-01-24