WOUND CARE TODAY
2015,Vol 2, No1
25
FOCUS ON OEDEMA
›
established that there are no sub-
clinical arterial problems, treatment
can commence.
MANAGEMENT OF OEDEMA
The Lymphoedema Framework
(2006) recommend four cornerstones
for the management of oedema:
›
Skin care
›
Exercise/lifestyle advice
›
Compression therapy
›
Lymphatic drainage.
Skin care
Effective skin care is essential to
help reduce the risk of hard dry skin,
ulceration and infection. Patients
should be encouraged to inspect
their skin for irregularities and
apply emollients or soap substitutes.
Emollient therapy can help to maintain
the skin barrier function and has the
following benefits (Ersser et al, 2007):
›
Occlusive — trapping water in
the stratum corneum
›
Active — moving water from the
dermis to the epidermis
›
Exfoliative
›
Anti-inflammatory
›
Antimitotic
›
Antipruritic
›
Accelerates regeneration of
skin barrier.
Exercise/lifestyle advice
Exercise and mobility will generally
help to improve the calf muscle
pump action, which, in turn, aids
venous return and lymph drainage.
In addition, referral for weight
management and or surgical
intervention such as gastric bypass
may be appropriate, as may various
venous interventions such as
endovenous laser therapy or foam
sclerotherapy.
Compression therapy
Effective compression should provide
a balance between exerting too little
and too much pressure. Too little
pressure is ineffective in reducing
oedema, while too much may not be
tolerated by the patient and can cause
damage to the arterial system and/
or bony/prominent parts of the limb
(Lymphoedema Framework, 2006).
After a set of measurements
has been taken and once a
compression system (usually
bandages or hosiery garments)
has been chosen by the nurse
and patient, it should be applied
according to the manufacturer’s
instructions. To achieve optimum
results for the patient it is essential
that practitioners have a working
knowledge of how the chosen
compression system works. One of
the key aims of management is to
reduce the limb size/volume and
then maintain it.
Compression should be used
with caution under specialist
supervision in patients with arterial
insufficiency (demonstrated by
an ABPI less than or equal to 0.8)
(SIGN, 2010). It is also important to
consider the results of the holistic
assessment alongside those of the
vascular assessment.
Lymphatic drainage
Manual lymphatic drainage
(MLD) is a technique which uses
massage to reduce swelling by
encouraging lymphatic flow (Quéré
and Sneddon, 2009). Together with
compression, this technique provides
psychological benefits and symptom
relief. MLD and compression should
be used in combination to achieve
the best outcome.
Patients should also be
encouraged to control their weight,
take exercise and maintain good
skin care.
CONCLUSION
Chronic oedema is an incurable and
lifelong condition for which there
may be more than one cause and
which may be exacerbated by other
medical conditions.
In the early stages of oedema
(i.e. before it becomes chronic), the
patient’s skin will be soft and pitting.
Once recognised, treatment with
elevation and compression therapy
can help to reduce the swelling. The
development of oedema is such that
the signs and symptoms increase in
severity as the disease progresses.
The management of chronic
oedema must be holistic,
and involve the patient and
the multidisciplinary team.
Management should also include
treatment of any underlying
medical conditions; reduction of
oedema through leg elevation;
exercise; the application of
effective compression; and skin
care to prevent breaks and possible
infection and cellulitis.
WCT
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