We utilize the pedal pump
to try to augment the lymphatic
flow from the lower extremities.
We want to try to apply a gentle oscillation
to try to promote an inflow.
Remember, prior to applying pedal pumps, you want to make
the diaphragms are opened up. You want to
make sure there’s no contraindications
to the pedal pumps such as DVT, or fracture,
or any other potential malignancy
that the patient may have, or high fevers
where you could potentially spread infection.
In order to perform the technique,
what we want to do
is to place our palms on the bottom
of the feet here.
Dorsiflex the ankles and do a little bit
of a gentle oscillation back and forth.
What you want to note
is that the patient’s nose
is kind of moving back
and forth a little bit.
Now, there’s a proper rate and
rhythm for each patient.
It could be a little bit slower.
It could be a little bit quicker.
You want to kind of pay attention
to the amount of force that you’re utilizing
and try to match the resistance
in the tissues here.
What you’ll find is that as you’re performing
this, you’ll start to feel
a decreased resistance. Then you know the technique is
Usually, rule of thumb, 30 seconds
to 2 minutes might be the average time
for performing the pump technique.
Once you complete
and you feel a little bit of a change, you can
come back, reassess the extremities
to see if there’s improved swelling, if there’s decreased
tension in the tissue,
to see if the technique was successful.
Thoracic lymph pump. What we want to do
with the thoracic lymph pump
is to encourage lymph flow
throughout the thoracic cage,
to help profuse the lungs and improve
lymph flow to help with the immunity.
The thoracic pump, what we’re going to
do is we’re going to place our hands
just underneath the clavicle. We’re going to
create a little bit of an oscillatory force.
This force will allow for
increased lymphatic flow.
You could continue this oscillation
for about 30 seconds to a minute
as tolerated by the patient. Afterwards,
you can come back and recheck
to see if that improves lymphatic flow.
We could also utilize thoracic pump
using respiratory assist. So, what the patient
is going to do is they’re going to breathe
deeply in and out. We’re going to try
to encourage more negative pressure.
We’re going to keep keeping
the upper ribs in exhalation.
We’re going to place the hands
in the same position.
Have the patient take a
breath in and breathe out.
When they breathe out, you’re going to
keep those upper ribs in exhalation.
Breathe in again
and breathe out.
Each time, you’re going to further
hold the ribs in exhalation.
One more time.
Breathe in and breathe out.
Then on the last breath,
you’re going to suddenly let go.
That causes a sudden change
between the negative pressure
and then the positive pressure rushing in.
A lot of times, I will use that technique
to try to improve respiratory excursion if they’re
having a lot of chest congestion.
If they need to kind of bring something up, they’ll
help kind of drive things out of the lung.
But you do have to warn the
patient that they may start
getting into a little bit of a coughing
fit when that occurs.
We could also utilize thoracic
pump from a side approach.
Here, what we’re going to do is
we’re going to grab the arm,
take the hand and put it underneath
our arm to support it.
So what we’re going to do is
we’re going to traction the arm.
Because of the shoulder’s
attachment to the serratus,
it’s going to pull those
ribs into inhalation.
So we could have the patient take
a breath in and I lean back.
When the patient breathes out, I’m going to
bring the ribs into exhalation.
I’m going to release that pull from the arms.
Again, take a breath in.
This helps to encourage the ribs going to
inhalation and breathe out.
That goes into exhalation.
You could do this several cycles,
breathing in and then breathing out,
helping to encourage the ribs
to move into inhalation
You could also do it as a pump technique
itself without respiratory cooperation,
a little bit of a traction and compression
up and down the lateral aspect of the ribs
which then helps to articulate the ribs and
get the ribs moving a little bit more.
Afterwards, you can come back
and recheck the rib excursion
and see if the patient has improved
mobility of the thoracic cage.
The liver pump could be performed
to try to promote increased
and to try to improve the
function of the liver itself.
We’re going to contact the lower
ribs on the right side here
and gently place our fingers
over the region of the liver
and then create a little bit
of a gentle oscillatory pump.
This is to try to encourage drainage,
motion and movement
of circulation surrounding the liver.
After you do this pump
for 30 seconds to a minute, you could come back and double
Make sure prior to performing
the technique, you ensure that
there’s no contraindications. The patient
doesn’t have enlarged liver
or any other concerns that may
be a contradiction for this technique.
We utilize the splenic pump
to try to boost immunity and to help demarginalize those
and get them into circulation. For the splenic
pump, we’ll get our hands
underneath the lower rib cage and
underneath the left costal margin
and then provide a little bit
of a gentle oscillatory force.
This oscillation should be gentle. You should make sure that
performing this technique.
You want to make sure
the patient doesn’t have mono
or any other potential causes
for having a large spleen.
So after performing the oscillation
30 seconds to a minute,
you can come back and then
reassess to make sure that
the area feels a little
bit less tense.