The information that has been passed to me (via lymph experts) was that pumps
cause long term damage to the lymphatic system. However, when reading the
literature, one thing that stands out is that the pump pressures and times have
decreased significantly over the past 20 years. And while none of the
literature says it, I would imagine that the decreased pressure on the
superficial lymphatic structures causes less (or no damage to the system). That
being said, we do need to be very thoughtful about who gets a pump and why.
In the adult population (which likely carries over to teens/young adults),
there seems to be a net benefit to the use of pump when used in conjunction
with daily compression and some proximal manual lymphatic drainage. If our
patients are not willing to wear garments, they should not waste the time and
money to have a pump. There is no evidence that true lymphedema will be reduced
with the use of pump and no compression.
I work in pediatrics, and in this setting there is zero evidence that the pump
works. My guess is that it’s very difficult to study pumps in pediatrics,
partly because the pumps are not the right size for kids. My experience in
providing manual lymph drainage and bandaging in kids is that the tissues are
extremely pliable, and we are able to reduce most edema quickly without the
need for a pump. Offering a pump to a family prior to a trial of PT makes them
think that pumps are instead of CDT, not as an augment to the treatments we
already provide.
The 2 issues that I would worry about the most with use of the pump are genital
edema, and proximal volume overload (without the patient knowing how/when to
report/stop). If a patient is compliant with coming to PT for education, manual
lymph drainage and wearing garments, then a pump may be a great way to give
them long-term independence.
Bottom line is... if a patient is already compliant with wearing garments,
regular replacement of garments and finds that regular MLD is helpful... then a
pump on the lowest effective setting could give them long term independence. If
they are not wearing garments, then they should not have a pump.
Andrea
Andrea Richtel Branas PT, DPT, MSE
Certified Lymphedema Therapist
Physical Therapist
Division of Rehabilitation
Children's Hospital of Philadelphia
branasa@xxxxxxxxxxxxxx
________________________________
From: aptaoncology-bounce@xxxxxxxxxxxxx <aptaoncology-bounce@xxxxxxxxxxxxx> on
behalf of Louis-Ferdinand, Amelia <alf@xxxxxxxxxxxxx>
Sent: Wednesday, June 30, 2021 11:52 AM
To: aptaoncology@xxxxxxxxxxxxx <aptaoncology@xxxxxxxxxxxxx>
Subject: [External][aptaoncology] Re: Lymphedema pump question
https://klosetraining.com/2013/11/22/to-pump-or-not-to-pump/<https://nam10.safelinks.protection.outlook.com/?url=https%3A%2F%2Fklosetraining.com%2F2013%2F11%2F22%2Fto-pump-or-not-to-pump%2F&data=04%7C01%7CBRANASA%40chop.edu%7C4346cef2c9f94265be1208d93bdf1f8f%7Ca611241607b041a59bb1d146b575c975%7C1%7C0%7C637606652355151095%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C2000&sdata=tLqzjNbuIvo75A4IPS3uS9FS8oF071c5JLIgqetTlJ0%3D&reserved=0>
I don’t use pumps often so might not be the best in recommending specifics but
when I do or if I come across a patient who already has one and wants feedback
on settings I generally use this info. IF there is more updated info would
love feedback on that myself.
Best-Amelia
Amelia Louis-Ferdinand PT, OCS, CLT-UE
Clinical Specialist
Physical Therapy
Burlington Bldg Lower Level Suite 1
325 E. Eisenhower Pkwy., SPC 5744 | ANN ARBOR, MI 48108
OFFICE: 734-763-6464
[Macintosh HD:Users:andreascafasci:Desktop:Work:Finalized logos:Michigan
Medicine:Signature-Marketing-Blue-Bug.png]
From: aptaoncology-bounce@xxxxxxxxxxxxx <aptaoncology-bounce@xxxxxxxxxxxxx> On
Behalf Of Mary Fisher
Sent: Wednesday, June 30, 2021 9:35 AM
To: aptaoncology@xxxxxxxxxxxxx
Subject: [aptaoncology] Lymphedema pump question
External Email - Use Caution
Hi all,
Just looking for what criteria you use to determine if someone would benefit
from a lymphedema pump. If so, what are the brands recommended? What
parameters?
Mary I. Fisher, PT, PhD | Chair and Associate Professor
Board-Certified Clinical Specialist in Orthopedic Physical Therapy
Certified Lymphedema Therapist
[https://drive.google.com/a/udayton.edu/uc?id=1N6UKsbkIkfW6PWDABVow29TC3ZGNeNnn&export=download]
300 College Park | Dayton, OH 45469-2925
mary.fisher@xxxxxxxxxxx<mailto:mary.fisher@xxxxxxxxxxx> | Telephone:
937.229.5617 | Facsimile: 937.229.5601
she/her/hers
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