Akademik Veri Yönetim Sistemi
5TH INTERNATIONAL IZMIR CONGRESS ON MEDICINE, NURSING, MIDWIFERY, AND HEALTH SCIENCES PROCEEDINGS BOOK, İzmir, Türkiye, 18 - 20 Temmuz 2024, ss.243-245
Background: Lymphedema occurs as a result of the accumulation of lymph fluid due to blockages in lymphatic system. This condition, commonly seen in the arms or legs, can arise from causes such as surgical intervention, radiation therapy, or infections. Treatment of lymphedema involves manual lymph drainage, compression therapy (bandages or compression garments), exercise, and skin care, along with pneumatic compression therapies. These treatments aim to reduce and control the edema. However, specialized training is required to perform manual lymph drainage techniques in clinics, which often leads to the use of pneumatic compression devices for treatment. These devices come with various complications, particularly the pressure they exert on tissue (approximately 100-150 mmHg), which can damage lymph collectors. Additionally, number of compressions these devices apply to the tissue per minute ranges from 1-5, and the pressure is applied horizontally to tissue. This contradicts the physiological working principles of lymph collectors.
Objective: In light of this information, objective of the research is to develop a device that can simulate manual lymph drainage by mimicking the peristaltic movements of lymph collectors, with contraction frequencies, directions, and pressure levels that they can tolerate when stimulated.
Methodology: Methodology of the research involves developing a device to replicate manual lymph drainage applications by applying pressure between 40-80 mmHg in direction of collectors and performing manual applications on the tissue 50-120 times per minute. The device uses a mechanism where air progresses gradually, making contact with the tissue at specific pressures (40-80 mmHg) and advancing parallel to collectors. The first completed prototype is 50 cm long, consisting of cells, each with a width of 2 cm. Synchronous valves are placed at the entrance and exit of cells, and a manometer is connected in parallel to the system to monitor the pressure within the system. The pressure of the air entering the system is controlled by a manometer at the tank's outlet, allowing air to enter and exit the system at a pressure between 0.5 – 0.8 bar. Two force sensors were integrated into the system at varying distances to track the peristaltic movement completed per minute. Delays on the force sensors were noted for peristaltic movements completed at 50, 100, and 120 per minute. This confirmed occurrence of peristaltic movement and identified the efficient delay frequencies. Additionally, effectiveness of 3-minute applications at different frequencies was evaluated using three liquids with different viscosity values. The three liquids with varying viscosities were positioned in three lines at tissue contact areas of the system for measurement.
Results: In the effectiveness evaluations conducted using the peristaltic movement measurement methods, it was observed that there was no temporal delay in setups where aim was to complete 50, 100, and 120 movements per minute with a distance difference of 6 cm. When the distance between two force sensors was 14 cm, the delay differences between the force sensor near the air inlet and the force sensor near the air outlet were found to be 94 milliseconds for 50 movements per minute, 47 milliseconds for 100 movements per minute, and 49 milliseconds for 120 movements per minute. Similarly, with a distance of 22 cm, the delays were 141 milliseconds for 50 and 100 movements per minute and 94 milliseconds for 120 movements per minute. When the distance between the two force sensors was increased to 30 cm, the delays were 168 milliseconds for 50 movements per minute, 141 milliseconds for 100 movements per minute, and 94 milliseconds for 120 movements per minute.
In the evaluations related to liquid transportation capacity, studies were conducted on transportation of liquids with three different viscosities (high, medium, and low viscosity). Measurements were conducted at different targeted peristaltic movement speeds. For measurements, leak-proof containers were placed at the air entry and exit points of the system, and weight differences between two containers were taken as the criterion. In the evaluations with low viscosity liquid, it was observed that 0.09 grams of liquid was transported in the setup performing 50 peristaltic movements per minute, 1.37 grams in the setup performing 100 peristaltic movements per minute, and 0.98 grams in the setup performing 120 peristaltic movements per minute. In the measurements with medium viscosity liquid, 0.14 grams was transported in the setup performing 50 peristaltic movements per minute, and 0.4 grams in the setups performing 100 and 120 peristaltic movements per minute. In the evaluations with high viscosity liquid, it was observed that 0.06 grams was transported in the setup performing 50 peristaltic movements per minute, 0.3 grams in the setup performing 100 peristaltic movements per minute, and 0.42 grams in the setup performing 120 peristaltic movements per minute.
According to data received from the force sensors, pressure values measured in the areas intended to contact tissue were found to be between 50-100 mmHg.
Conclusion: Based on the measurements conducted, it was determined that applications performing 100 peristaltic movements per minute could be more effective in liquid transportation. In this study, our newly developed device for lymphedema treatment, which simulates manual lymph drainage, has been shown to be capable of performing applications at desired frequencies and pressures when positioned parallel to the collectors. It can facilitate the transportation of interstitial fluid, offering a different perspective for lymphedema treatment.
Acknowledgements: Our research was supported by the “TUSEB A Grubu Acil Ar-Ge” Project Support Program.
Keywords: Lymphedema, lymphedema treatment, health technologies