best practice for the management of lymphoedema ... - EWMA
best practice for the management of lymphoedema ... - EWMA
best practice for the management of lymphoedema ... - EWMA
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Checking fit<br />
A trained practitioner should check that a<br />
newly prescribed garment is as ordered, fits<br />
properly and fully covers <strong>the</strong> area requiring<br />
treatment. Initial fitting should include a<br />
demonstration <strong>of</strong> how to put on and remove<br />
<strong>the</strong> garment, and observation and<br />
assessment <strong>of</strong> <strong>the</strong> patient's/carer's<br />
application and removal techniques. Clear<br />
verbal and written instructions should be<br />
given on errors <strong>of</strong> fit that may be discovered<br />
after first wearing, and on how to care <strong>for</strong><br />
<strong>the</strong> garment (Box 33).<br />
BOX 33 Application and care <strong>of</strong> compression<br />
garments<br />
Patients and carers should be advised that:<br />
■ All folds and wrinkles should be removed.<br />
This can be assisted by wearing household<br />
rubber gloves whilst smoothing <strong>the</strong> garment<br />
■ Emollients may damage compression<br />
garments. Ensure emollient is absorbed<br />
be<strong>for</strong>e donning garment or use products<br />
approved by <strong>the</strong> garment manufacturer.<br />
A cotton liner can be used if emollient is<br />
applied just be<strong>for</strong>e donning, <strong>the</strong> skin is at risk<br />
<strong>of</strong> trauma, or <strong>the</strong>re is dermatitis<br />
■ Compression garments should not be worn<br />
with <strong>the</strong> top folded down<br />
■ Garments combining an armsleeve and<br />
gauntlet should not be worn with <strong>the</strong><br />
handpiece folded back<br />
■ Any distortion in limb shape, skin<br />
redness/damage/discolouration, or<br />
peripheral swelling may indicate garment<br />
unsuitability<br />
■ The garment should be removed immediately<br />
if problems occur and <strong>the</strong> patient should<br />
contact <strong>the</strong>ir practitioner<br />
■ Garments should be washed frequently<br />
according to <strong>the</strong> manufacturer's instructions<br />
(per<strong>for</strong>mance may be impaired by infrequent<br />
washing)<br />
At follow up visits, <strong>the</strong> practitioner should<br />
check that <strong>the</strong> patient is concordant with<br />
garment wear, that <strong>the</strong> garment has not<br />
been altered, and that swelling is not<br />
occurring proximal or distal to <strong>the</strong> garment.<br />
Avoiding problems<br />
Garment slippage can be overcome in a<br />
number <strong>of</strong> ways (Box 34). A variety <strong>of</strong> aids is<br />
available <strong>for</strong> easing application <strong>of</strong><br />
compression garments (Box 35). Aids also<br />
exist to assist with garment removal.<br />
Oily or greasy emollients can damage<br />
compression garments and make garment<br />
application difficult. A cotton underlayer<br />
can be used to assist application and<br />
minimise damage.<br />
Garment replacement<br />
Garments should be replaced every three<br />
to six months, or when <strong>the</strong>y begin to lose<br />
elasticity. Young or very active patients<br />
may require more frequent garment<br />
replacement.<br />
ALLERGY AND COMPRESSION<br />
GARMENTS<br />
Patients may develop an allergy to<br />
compression garments. Allergens include<br />
fabric dye, latex and nylon. If an allergy is<br />
suspected:<br />
■ treat contact dermatitis appropriately<br />
■ use garments without latex<br />
■ use garments with high cotton content,<br />
or that have double covered yarns to<br />
limit skin contact with elastic<br />
components<br />
■ consider <strong>the</strong> use <strong>of</strong> a cotton tubular<br />
bandage underlayer (which must be<br />
unwrinkled during wear) or a garment<br />
with an inbuilt lining.<br />
COMPRESSION GARMENTS FOR<br />
LIMBS<br />
The following recommendations <strong>for</strong><br />
compression garments <strong>for</strong> <strong>the</strong> lower limb<br />
(Figure 43 and Table 7) and <strong>for</strong> <strong>the</strong> upper<br />
limb (Table 8) have been developed by <strong>the</strong><br />
British Lymphology Society compression<br />
garments group and <strong>the</strong> Lymphoedema<br />
Framework working groups.<br />
Patients with severe shape distortion<br />
may find flat knit garments more<br />
appropriate. However, <strong>the</strong> finer finish <strong>of</strong><br />
circular knit hosiery may make it more<br />
cosmetically acceptable.<br />
If <strong>the</strong> patient is unable to tolerate <strong>the</strong><br />
<strong>the</strong>rapeutically indicated level <strong>of</strong><br />
compression, lower pressure garments<br />
may be necessary to encourage<br />
concordance.<br />
Tolerability <strong>of</strong> high levels <strong>of</strong> compression<br />
may be enhanced by layering garments.<br />
COMPRESSION<br />
GARMENTS<br />
BOX 34 Avoiding<br />
compression garment<br />
slippage<br />
Ensure garment fits correctly<br />
Ensure style is appropriate<br />
Consider:<br />
■ skin glue or surgical<br />
adhesive tape<br />
■ silicone coated band at top<br />
edges<br />
■ fixation mechanism - eg<br />
waist fastening/half<br />
panty/full panty/shoulder<br />
cap/bra attachment and<br />
strap<br />
BOX 35 Application aids<br />
■ Garment application<br />
gloves<br />
■ Glide on applicator<br />
■ Silk slippers<br />
■ Anti-slip mat<br />
■ Metal applicator frames<br />
BEST PRACTICE FOR THE MANAGEMENT OF LYMPHOEDEMA 43