Lymphedema Risk Reduction Practices- National Lymphedema Network

POSITION STATEMENT OF THE NATIONAL LYMPHEDEMA NETWORK

By NLN Medical Advisory Committee; Next Revision Date Spring 2011

TOPIC: LYMPHEDEMA RISK REDUCTION PRACTICES

I. Skin Care - Avoid trauma / injury to reduce infection risk1,2 • Keep extremity clean and dry • Apply moisturizer daily to prevent chapping/chafing of skin2 • Attention to nail care; do not cut cuticles

• Protect exposed skin with sunscreen and insect repellent • Use care with razors to avoid nicks and skin irritation • If possible, avoid punctures such as injections and blood draws • Wear gloves while doing activities that may cause skin injury (i.e., washing

dishes, gardening, working with tools, using chemicals such as detergent) • If scratches/punctures to skin occur, wash with soap and water, apply antibiotics,

and observe for signs of infection (i.e. redness) • If a rash, itching, redness, pain, increased skin temperature, fever or flu-like

symptoms occur, contact your physician immediately for early treatment of possible infection3

II. Activity / Lifestyle

• Gradually build up the duration and intensity of any activity or exercise4-8 • Take frequent rest periods during activity to allow for limb recovery • Monitor the extremity during and after activity for any change in size, shape,

tissue, texture, soreness, heaviness or firmness9 • Maintain optimal weight10-13

III. Avoid Limb Constriction9 • If possible, avoid having blood pressure taken on the at-risk extremity • Wear loose fitting jewelry and clothing

IV. Compression Garments2,9,14 • Should be well-fitting • Support the at-risk limb with a compression garment for strenuous activity (i.e.

weight lifting, prolonged standing, running) except in patients with open wounds

or with poor circulation in the at-risk limb15 • Consider wearing a well-fitting compression garment for air travel16,17

NLN ♦ 116 New Montgomery Street, Suite 235 ♦ San Francisco, CA 94105 Tel: 415-908-3681 ♦ Fax: 415-908-3813 Infoline: 1-800-541-3259 ♦ Email: nln@lymphnet.org ♦ Online: www.lymphnet.orgNLN Position Paper: Lymphedema Risk Reduction Practices Page 2 of 4

V. Extremes of Temperature1 • Avoid exposure to extreme cold, which can be associated with rebound swelling,

or chapping of skin • Avoid prolonged (greater than 15 minutes) exposure to heat, particularly hot tubs

and saunas • Avoid placing limb in water temperatures above 102°Fahrenheit (38.9°Celsius)

VI. Additional Practices Specific to Lower Extremity Lymphedema

• • •

Avoid prolonged standing, sitting18 or crossing legs Wear proper, well-fitting footwear and hosiery19,20 Support the at-risk limb with a compression garment for strenuous activity except in patients with open wounds or with poor circulation in the at-risk limb15

NOTE: Given that there is little evidence-based literature regarding many of these practices, the majority of the recommendations must at this time be based on the knowledge of pathophysiology and decades of clinical experience by experts in the field.