What are the different kinds of compression for edema?

Different Types of Compression Therapy for Edema

Compression therapy comes in multiple forms including graduated compression stockings, inelastic bandages, multilayer wraps, and intermittent pneumatic compression devices, each with specific pressure ranges and applications for treating edema. The choice depends on the severity of edema, location, and patient factors.

Graduated Compression Stockings (GCS)

• Pressure ranges:

  • Light support: 8-15 mmHg
  • Class A: 10-14 mmHg
  • Class I: 15-21 mmHg
  • Class II: 23-32 mmHg
  • Class III: 30-40 mmHg

• Applications:

  • Mild edema: 10-20 mmHg
  • Moderate edema: 20-30 mmHg
  • Severe edema: 30-40 mmHg 1

• Styles:

  • Knee-high: Sufficient for most patients with symptoms below the knee
  • Thigh-high: For symptoms extending above the knee
  • Pantyhose style: For bilateral symptoms or extending to the groin 1

• Key considerations:

  • Should be applied in the morning before edema develops
  • Compression should focus primarily over the calf rather than just the ankle
  • For elderly patients (≥65 years), especially those with arthritis, hallux valgus, or digitus flexus, lower compression (18-21 mmHg) may provide better wearing comfort and compliance than higher compression (23-32 mmHg) 2

Inelastic Bandages

• Characteristics:

  • Minimal stretch
  • High working pressure (during movement) and lower resting pressure
  • Requires skilled application

• Pressure ranges:

  • Upper extremity: Optimal around 20-30 mmHg (higher pressures may be counterproductive)
  • Lower extremity: Optimal around 50-60 mmHg (pressures above this may decrease effectiveness) 3

• Applications:

  • Initial treatment of moderate to severe edema
  • Better for wound healing at 30-40 mmHg than elastic bandages 1
  • Safe at reduced pressure (20-30 mmHg) for patients with ankle-brachial indices between 0.6-0.9 1

Multilayer Compression Systems

• Characteristics:

  • Typically 2-4 layers of different materials
  • Combines elastic and inelastic components
  • Provides sustained compression over time

• Applications:

  • Venous ulcers
  • Severe edema
  • Can maintain compression for up to a week

Double Stocking Systems

• Characteristics:

  • Consists of a liner stocking and outer stocking
  • Each layer provides approximately 20 mmHg pressure
  • Combined pressure of approximately 40 mmHg

• Applications:

  • Alternative to bandaging for initial therapy
  • Equally effective as short-stretch bandaging in reducing leg volume (13% reduction after 1 week)
  • Simpler application and reduced staffing costs 4

Intermittent Pneumatic Compression Devices

• Characteristics:

  • Sequential inflation and deflation of air chambers
  • Adjustable pressure settings
  • Available in various configurations (leg, arm, whole body)

• Applications:

  • Moderate to severe edema with significant swelling
  • Post-thrombotic syndrome (PTS)
  • Can improve edema in 80% of patients with severe PTS 5
  • Reasonable option for patients with moderate or severe PTS and significant edema 5

• Limitations:

  • Expense and inconvenience
  • Requires several hours of daily use 5

Special Considerations

1. Contraindications:

   • Arterial insufficiency (ABI <0.6)
   • Severe peripheral neuropathy
   • Acute dermatitis or cellulitis
   • Massive edema where compression may impair circulation 1

2. Pressure optimization:

   • Upper extremity: Optimal pressure around 30 mmHg
   • Lower extremity: Optimal pressure 50-60 mmHg
   • Higher pressures may be counterproductive 3

3. Acute injuries:

   • Compression wraps should be applied without compromising circulation
   • Limited to 20-30 minutes, 3-4 times daily
   • Proper fit is essential to avoid overtightening 1

4. Patient compliance:

   • Major limitation of compression therapy
   • Can be improved by selecting appropriate compression modality and providing adequate education 6
   • For elderly patients, lower compression levels may improve compliance 2

Practical Algorithm for Selecting Compression Type

1. For mild edema or prevention:

   • Graduated compression stockings (10-20 mmHg)
   • Apply in morning before edema develops

2. For moderate edema:

   • Graduated compression stockings (20-30 mmHg) or
   • Double stocking system or
   • Inelastic bandages if skilled application available

3. For severe edema:

   • Initial: Inelastic bandages (30-40 mmHg for lower extremity)
   • Maintenance: Class III compression stockings (30-40 mmHg)
   • Consider intermittent pneumatic compression if inadequate response

4. For post-thrombotic syndrome:

   • Trial of graduated elastic compression stockings (30-40 mmHg)
   • For moderate/severe cases with significant edema, consider intermittent compression device 5

Compression therapy remains the cornerstone of treatment for venous and lymphatic edema, with diuretics often overused as primary therapy 6. The optimal compression modality should be selected based on the severity of edema, location, patient factors, and available resources.