For lymphedema therapists and prescribing providers
Pump settings should match the diagnosis, the stage, the tissue and the patient in front of you. This quick reference gives starting pressures and session times for the four conditions we see most often, plus the special situations that change the plan. Always check for contraindications first.
Starting pressures by condition
Venous ulcer / venous stasis
Low compression — under 40 mmHg: patients with wounds, insensate or fragile tissue. Can be increased with monitoring if there is no adverse response.
Moderate compression — 40–60 mmHg: most patients.
High compression — over 60 mmHg: extreme fibrotic changes or lipodermatosclerosis.
Sessions: 60 minutes once or twice a day. Shorter, more frequent sessions may help patients who can comply. Afternoon or evening sessions usually give the best response.
Lower extremity lymphedema
Low to moderate compression — 30–60 mmHg: low to normal body mass, Stage 1 or Stage 2 lymphedema, or patients with wounds, insensate or fragile tissue. Can be increased with monitoring if there is no adverse response.
Moderate to high compression — over 60 mmHg: Stage 3 lymphedema, heavy fibrosis and/or high body mass. Use under 40 mmHg over the abdomen for comfort.
Sessions: 60 minutes once or twice a day. Shorter, more frequent sessions may help patients who can comply. Afternoon or evening sessions usually give the best response.
Upper extremity / post-breast cancer lymphedema
Low to moderate compression — 30–50 mmHg: low to normal body mass, Stage 1 or Stage 2 lymphedema, or patients with wounds, insensate or fragile tissue. Can be increased with monitoring if there is no adverse response.
Moderate to high compression — 40–60 mmHg: Stage 2 or Stage 3 lymphedema, heavy fibrosis or high body mass. Use under 40 mmHg over the torso for comfort.
Sessions: 60 minutes once or twice a day.
Lipedema
Low compression — 20–40 mmHg: low to normal body mass, low swelling in the feet and ankles, low amounts of fibrosis. 60 minutes once or twice a day.
Moderate compression — 40–50 mmHg: moderate swelling, fibrosis and/or increased body mass. 60 minutes once or twice a day; afternoon or evening sessions give the best response.
High compression — over 50 mmHg: profound swelling, fibrosis and/or high body mass (over 200 lbs). 60 minutes once or twice a day; afternoon or evening sessions give the best response.
Special considerations
Congestive heart failure
Decompensated cardiac failure is a contraindication to pump use. Patients recently hospitalized for CHF should get physician clearance before starting. Patients with a history of CHF should be monitored for shortness of breath, an increased or labored breathing rate, lung crackles, cardiac gallop and jugular vein distension. Patients who must avoid lying flat because of shortness of breath need close physician monitoring if they use pneumatic compression.
Monitor symptoms during and after treatment.
Start at low pressure (under 35 mmHg) with short sessions (under 30 minutes), then increase pressure and time gradually based on tolerance and response.
For first leg treatments, pump one leg, then treat the second leg the next day or next session. If symptoms do not worsen, both legs can be treated together.
With pants-style garments, treat both sides at low pressure for short sessions (30 minutes, under 35 mmHg) and increase gradually each session as tolerated.
Patients treated in the hospital can receive IV diuretics before treatment. Start treatment after urine output is established. Pulse oximetry can be used to monitor lung function.
Mixed venous and arterial disease
Some patients with venous stasis ulcers also have arterial insufficiency. With an ABI of 0.6 to 0.8, use BioCompression pumps with caution: lower pressures and frequent skin checks. Do not use BioCompression pumps when the ABI is under 0.6.
Deep vein thrombosis (DVT)
Patients with a history of DVT should have a Doppler ultrasound to rule out DVT before treatment starts. Treatment of post-thrombotic syndrome is at the discretion of the prescribing physician.
Cellulitis
Avoid pneumatic compression during an acute infection. Treatment may resume 48–72 hours after antibiotics are started.
Patients who need help
If a patient cannot operate the pump or put on, take off or adjust the garments, a family member or caregiver should be available to help for the whole session.
Pump features for special situations
Calibrated gradient pressure: set different pressures in specific areas of the garment, such as lower pressure over sensitive areas and higher pressure where needed along the limb.
Focus treatment: adds extra treatment to a selected area after the main session, finishing with a distal-to-proximal massage sequence.
Pause / hold time: sets the length of the pause and the proximal hold between cycles.
How we can help
Midwest Compression fits and sets up BioCompression pumps for lymphedema, lipedema and venous patients. We set up the pump, program the starting settings your order calls for, and show the patient how to use it at home. Orders can be sent through Parachute Health. Email customersupport@midwestcompression.com or call 800-883-1549.
Want this for your team? Book a free 45-minute virtual staff in-service, or read Getting a Pump Approved: E0651 vs. E0652 for the documentation side.
This is a guide for medical professionals. Each patient must be assessed individually for appropriate use of compression pump therapy.
Source: Adapted from Quick Reference Guide – Compression Pump Settings (Midwest Compression physician reference for BioCompression pneumatic compression pumps, revised November 2024).