best practice for the management of lymphoedema ... - EWMA

COMPRESSION
GARMENTS
FIGURE 39 Circular knit machine
Garments are shaped by varying
yarn tension and stitch height
during knitting.
FIGURE 40 Flat knit handpiece
before sewing
Garments are shaped by adding
and removing needles during
knitting.
that some manufacturers’ compression
class pressure ranges for lower limb hosiery
may be different from the compression class
ranges used for upper limb garments. To
assist comparison, therefore, garment
packaging and studies involving
compression garments should state the
pressure ranges and the testing method
used to determine the pressures.
LIMB SHAPE AND GARMENT
CHOICE
Limb shape plays an important role in
choosing compression garments. Ready to
wear compression garments are suitable
where there is no or minimal limb distortion,
but can be more difficult to fit precisely and,
if circular knit, may roll at the top. Custom
made garments can be made to
accommodate a wide range of anatomical
distortion. Flat knit garments do not roll,
curl, twist or tourniquet, can achieve a
better fit, and can be made with zippers to
aid application.
FITTING COMPRESSION GARMENTS
C Compression
garments for patients with
lymphoedema should be fitted by
appropriately trained practitioners.
Prescription of compression garments
should only be undertaken after full
assessment of the patient, and should take
into account factors such as the stage and
severity of the lymphoedema, the patient's
BOX 31 Tips for compression garment measurement
comfort, preferences, lifestyle,
psychosocial status, concurrent disease,
and ability to apply and remove garments.
Patients with skin problems such as
dermatitis or psoriasis and those with
known allergies to substances like elastane
benefit from the use of cotton rich
garments.
Patients should be measured for
garments when swelling has been
minimised, pitting oedema is absent or
minimal, any shape distortion optimised
and the area stabilised (Box 31).
Accurate measurement is important to
achieve correct fit of ready to wear and
custom made garments. Measurements
required will usually include
circumferential measurements at several
given sites and longitudinal measurements
between specified points (Figures 41 and
42). The prescription should also specify
style, knitted texture and any fixation or
attachment (Box 32).
Measurement for ready to wear or custom
made compression garments requires
that the practitioner has appropriate
training, and access to a practitioner with
training at specialist level.
■ Measure when the area is largely free from pitting oedema, ie immediately after removal of
compression bandages, or in the morning before swelling can develop
■ The measuring tape should be pulled firmly, but not so tightly that it indents the skin
■ Measure with the patient in the recommended position
■ Continue bandaging until the patient has received the prescribed garments
BOX 32 Components of a compression garment prescription
NOTE: FIGURES 41-42
These figures provide a guide to
measuring for compression hosiery.
Careful attention should be paid to the
specific measuring instructions of the
manufacturers from which garments are
ordered.
■ Quantity of garments (at least two – one for wearing, one for washing)
■ Manufacturer, style and garment code
■ Level of compression required
■ Knitted texture, ie circular knit or flat knit
■ Length
■ Fixation and attachment, if needed, eg silicone top, waist attachment
■ For ready to wear garments, state size
■ For custom made garments, provide measurements required by the manufacturer
■ Sex of the patient
■ Colour
40 BEST PRACTICE FOR THE MANAGEMENT OF LYMPHOEDEMA