Device of Lymphedema Pump Therapy Based on Pressure

Pump: Design and Development

Suryani D. Astuti

, Deny Arifianto

, Dewa A.G.M. Supartha

, Alfian P. Putra

, Tri A. Prijo

Department of Physics, Faculty of Science and Technology, Universitas Airlangga, Surabaya, Indonesia

Post Graduate Program in Biomedical Engineering, Universitas Airlangga, Surabaya, Indonesia

Biomedical Engineering Study Program, Department of Physics, Faculty of Science and Technology, Universitas

Airlangga, Surabaya, Indonesia

Keywords: Pressure pump, Lymphedema pump therapy, Microcontroller

Abstract: Breast cancer is a cancer with the highest prevalence in Indonesia and one of the factors that trigger

lymphedema. Lymphedema caused by disruption of the lymph flow due to removal of some lymph nodes

during breast cancer surgery causes swelling of the upper or lower extremities. Compression pump therapy is

a therapeutic technique for controlling swelling. This research aimed to design and development of pressure

pump based on microcontroller with good performance. The lymphedema pumps were made with 3 chamber

handcuffs which had 4 variations of pressure values, i.e. 20mmHg-30mmHg, 30mmHg-40mmHg, 40mmHg-

50mmHg, and 50mmHg-60mmHg which could be selected using push button. The reading of the air pressure

value on the handcuff used the MPX5050GP pressure sensor. The air control system uses Arduino UNO

ATMega 328 microcontroller. The result of performance test of pressure sensor to output voltage showed

correlation coefficient 99.93%. The result of pressure calibration showed 99.96% linearity. The assembled

lymphedema pump had the characteristic of a chamber which was able to inflate and deflate sequentially from

distal to proximal with the mean pressure on each chamber. So, the assembled pressure pump has a candidate

as lymphedema pump therapy.

1 INTRODUCTION

Cancer is one of the main causes of death in the world,

one of them is breast cancer (Torre et al., 2015). In

2013, Indonesia has over 0.5% of breast cancer

patients, which is about 61.682 cases. Breast cancer

is one the causes that could cause lymphedema.

Lymphedema is a swelling of the upper and lower

extremities that caused by disruption of the lymph

flow. Lymphedema in breast cancer occurs in the

upper limb of the axilla due to removal of some lymph

nodes during surgery (Harris et al., 2001).

Lymphedema causes discomfort, limb dysfunction,

and morbidity (Damstra and Partsch, 2009).

Lymphedema is a chronic disease that could not be

cured. However, there are several attempts that could

be made to control swelling and reduce pain, such as

exercising, wrapping the arms or legs,

massage/Manual Lymphatic Drainage (MLD), and

pneumatic compression. Pneumatic Compression

(IPC) is a therapeutic technique using a device that

called lymphedema pump (Moseley et al., 2007). In

Indonesia, the availability of the pumps is very

limited because of the price is expensive, while every

year, the patient with lymphedema in cases of breast

cancer is increase because of this situation so many

people are not handled properly. Therefore, it is

necessary to make lymphedema pump with good

performance and reasonable price. Feldman et al

(2012) has created a Lymphedema pump by giving an

air in the handcuffs with 3 chambers sequentially

from the bottom to upper limb on the upper extremity

(distal to proximal) (Feldman et al., 2012). When the

three of chamber is already expending, the chambers

would deflate alternately. This is intended to allow

the lymph fluid to flow out of the upper limb with

lymphedema. The purpose of this research is to make

a lymphedema pumps that has controls on the air

delivery system so that the chambers could expand

sequentially from distal to proximal and deflating

alternately. Handcuff consists of three chambers. In

this device also has a pressure setting using push

button. The pressure range is within 20 mmHg to 60

Astuti, S., Ariﬁanto, D., Supartha, D., Putra, A. and Prijo, T.

Device of Lymphedema Pump Therapy Based on Pressure Pump: Design and Development.

DOI: 10.5220/0007540502310235

In Proceedings of the 2nd International Conference Postgraduate School (ICPS 2018), pages 231-235

ISBN: 978-989-758-348-3

231

mmHg (Lee et al., 2011). There is an LCD to displays

the output of pressured that given to the patient.

2 MATERIALS AND METHODS

The ATMega328 pump consists of air pumps and

handcuffs. The expending handcuff would suppress

and force fluid, such as blood and lymph, out of the

pressurized area. Lymphedema pump component

consists of as follows.

2.1 Hardware

Hardware consists of air pumps, MPX5050GP sensor

circuit, solenoid valve control circuit, push button

circuit, on-off transistor circuit, LCD circuit, and

handcuff circuit. The block diagram of the

lymphedema pump is shown in Figure 1.

Figure 1: The diagram block of compression pump for

lymphedema therapy

2.1.1 Air Pump and Pressure Sensor

Lymphedema pump used air pump to compress the

air that flows in the output hole. This air pump has

same principle as the wind compressor, which

compress air so the air has a pressure than the outside

air pressure.

MPX5050GP sensor was used to detect the

changes of the air pressure by converting the pressure

into voltage. MPX5050GP sensor is a piezo-resistive

transducer consisting of a thin silicon chip, a circular

silicon diagram, and four piezo-resistors. When the

pressure is applied to the silicon, the flexural

diaphragm causes the resistance of the silicon to

change. The changeable resistor is connected to the

Wheatstone bridge so that the sensor output is

voltage. The output voltage (VO) of the Wheatstone

bridge could be obtained using Equation 2.1 (Lee et

al., 2011). The output data from MPX5050GP sensor

still in analogue voltage so it needs converting to

Analogue to Digital Converter (ADC). The digital

data is converted into pressure value using transfer

function of MPX5050GP in Equation 4 (Freescale

Semiconductor Technical Data, 2007).

=(S * P * VB) ±VOS

(1)

out

* (0,018 * P + 0.04)

(2)

=((V

out

– (0.04* V

))/(0.018* V

))

(3)

=(((V

out

– (0.04* V

))/(0.018* V

))*7,5)

(4)

= output voltage (mV)

S = sensitivity (mV/V/psi)

P = pressure (Psi)

VB = input voltage in Wheatstone bridge

VOS = offset error

out

= voltage form ADC

= 5 Volt

= the value of the pressure measured by the

sensor (kPa)

= the value of the pressure measured by the

sensor (mmHg), 1 kPa =7.5 mmHg

2.1.2 Handcuff

A handcuff circuit server to suppress the area that has

lymphedema, which is the upper limb. The handcuff

consists of three chamber that sewn together and

connected to a solenoid valve control circuit using a

hose.

2.1.3 Solenoid Valve

This circuit has a function to manage the outflow of

air so the handcuff could be expending or deflating

just like a massaging movement. Solenoid valve

control system in form of on-off control system,

which connects or disconnects electric current in the

solenoid valve. The type of this solenoid valve is

normally open, which means the piston is open when

there is no current flow. The operation of this

solenoid valve control circuit is shown in Table 1. If

the solenoid valve is 0, the solenoid valve is open so

that the air flow out of the chamber, ad if the solenoid

valve is 1, the solenoid valve is closed so the air could

not pass through the chamber.

Table 1: The Operation of Solenoid Valve

Solenoid Valve

Water flow in

Chamber 1

Chamber 2

Chamber 3

Out Chamber 1

Out Chamber 2

Out Chamber 3

ICPS 2018 - 2nd International Conference Postgraduate School

232

Valve consists of a magnetic coil that is controlled

by an electric current. The magnetic coil would

supply an electric current and produce a magnetic

field used to driven the piston (plunger) (Whitman et

al., 2012).

2.1.4 Arduino UNO, Liquid Crystal Display

(LCD) 2x16 Character, and Transistor

Arduino UNO ATMega328 based microcontroller

board be used as PWM (Pulse Widht Modulation)

output. This lymphedema pump use arduino uno as

the air control system. The LCD has a function to

display four variation of pressure valve, which are

20mmHg-30mmHg, 30mmHg-40mmHg, 40mmHg-

50mmHg, and 50mmHg-60mmHg and also a result

from MPX5050GP sensor. The on-off transistor

circuit serve as an automatic air pump switch to

channel the air into the solenoid valve control circuit.

2.2 Software

The programing was made using Arduino software.

After the pressure value is inserted, then the pump

would release air and solenoid valve 1 was open, and

the other solenoid valve would close. The air would

fill the chamber 1. The pressure value would be

displayed on the LCD. If the air pressure on chamber

1 has reached maximum pressure, then the solenoid

valve 2 open and the other solenoid valve is closed.

Air pumps emit air and fill chamber 2 and so on.

Pressure values would be displayed on the LCD. If

the air pressure on chamber 3 has reached maximum

pressure, then solenoid valve 4 would open and

solenoid valve 1, 2, 3 would open alternately. So that

air at each chamber would come out. If the insert

voltage is stopped, the air pump would stop pumping

and the fourth solenoid valve would open.

2.3 Performance Test and Analysis

The in-air pump test was carried out by pressure

calibration by using pressure meter (manometer). The

calibration was done by counting percentage of error.

MPX5050GP sensor pressure calibration was done by

connecting MPX5050GP sensor with manometer and

pump. The sensor performance test was performed by

measuring the output voltage of the MPX5050GP

sensor. MPX5050GP sensor performance test results

were used as input to calculate the pressure of the

lymphedema pump so it could be known that the

desired pressure value is appropriate

The pressure stability test of each chamber was

performed to determine the stability of the air

pressure that could be maintained in each chamber for

35 minutes. The pressure stability test time of each

chamber refers to the Huntleigh Physician Form

where the time required for 1-time therapy is 30-120

minutes. The data collection of pressure stability test

was done every 1 minute (Huntleigh, 2001). This

study used four variations of pressure for therapy,

20mmHg-30mmHg, 30mmHg-40mmHg, 40mmHg-

50mmHg, and 50mmHg-60mmHg. The cuff used is 3

chambers. Pressure stability test of each chamber is

performed for each pressure.

3 RESULTS AND DISCUSSION

3.1 Hardware

Hardware is divided into four circuit blocks, i.e. block

circuit 1 containing series of LCD and Arduino UNO,

circuit block 2 contains supply circuit, circuit block 3

contains MPX5050GP sensor circuit and on-off

transistor circuit, and circuit block 4 contains push

button circuit.

3.2 Performance Test MPX5050GP

Sensor and Pressure Calibration

MPX5050GP sensor performance test results data

were analysed using linear regression. Figure 2

showed a gradient line of 12.813. The line equation

for the best match is y=12.813x+225.12 with

correlation coefficient of 0.9993.

Figure 2: The linearity relationship of the pressure value

with the output voltage on MPX5050GP

The value of the air pressure used in this

lymphedema pump therapy is 20mmHg-60mmHg

(Lee et al., 2011). The calibration analysis of

MPX5050GP sensor pressure with pressure

calibration data manometer used a linear regression.

The best line gradient (m) was 0.955. The line

Device of Lymphedema Pump Therapy Based on Pressure Pump: Design and Development

233

equation for best match was y = 0.955x + 1.74 with

correlation coefficient of 0.9996.

3.3 Stability Test of Each Chamber

Pressure

The test results of pressure stability over time in

Figure 3 shows that chamber 1 at 20mmHg-30mmHg

pressure could be fully charged after 11, 9, and 15 s

respectively. The stability of air pressure with a

minimum limit of 20 mmHg and a maximum limit of

30 mmHg could be maintained for 33’20”, 9’14” (1

stability) and 22’58” (2

stability), and 5’9” (1

stability) and 24’1” (2

stability) for Chamber 1, 2,

and 3 respectively. A pressure of 30mmHg-40mmHg

could be fully charged after 12, 10, and 19 seconds in

chamber 1, 2, and 3 respectively. The stability of air

pressure with a minimum limit of 30 mmHg and a

maximum limit of 40 mmHg could be maintained for

7’23” (1

stability) and 25’34” (2

stability), 15’23”

stability) and 13’3” (2

stability), and 6’19” (1

stability) and 20’9” (2

stability) for chamber 1, 2,

and 3 respectively. 40mmHg-50mmHg pressure

could be fully charged after 12, 12, and 19 seconds

for chamber 1, 2, and 3 respectively. The stability of

air pressure with a minimum limit of 40 mmHg and a

maximum limit of 50 mmHg could be maintained for

15’51” (1

stability) and 11’52” (2

stability), 8’12”

stability) and 20’9” 2

stability), and for 11’17”

stability) and 21’14” 2

stability) for chamber 1,

2, and 3 respectively. 50mmHg-60mmHg pressure

could be fully charged after 16, 24, and 19 seconds

for chamber 1, 2, and 3 respectively. The stability of

air pressure with a minimum limit of 50 mmHg and a

maximum limit of 60 mmHg could be maintained for

3’21” (1

stability) and 24’42” (2

stability), 6’51”

stability) and 17’8” (2

stability), and 7’14” (1

stability) and 17’44” (2

stability) for chamber 1, 2,

and 3 respectively.

The assembled lymphedema pump has a pressure

value in the range of 20mmHg to 60mmHg according

to the standard pressure of the Intermittent Pneumatic

Compression (Partsch et al., 2008). Handcuff could

inflate sequentially from distal to proximal according

to the massage standard for lymphedema patients

especially lymphedema due to breast cancer surgery

and pressure on each chamber could be maintained

for more than 10 minutes (Damstra et al., 2008).

Figure 3: Stability pressure on chamber 1; (A) 20mmHg-

30mmHg pressure; (B) pressure 30mmHg-40mmHg; (C)

40mmHg-50mmHg pressure; (D) 50mmHg-60mmHg

pressure

4 CONCLUSIONS

Controlled pressure values of this device have the

same standard of the intermittent pneumatic

compression within range from 20 mmHg to 60

mmHg. The handcuff could inflate sequentially from

distal to proximal according to the massage standard

for lymphedema patients with pressure on each

chamber could be maintained for more than 10

minutes.

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