Lecture 9 Lymphedema Flashcards
Rationale for Complete Decongestive Therapy
- Move excessive lymphatic fluid into healthy lymph vessels in adjacent quadrants
- Promote additional lymphatic drainage and prevent fluid re-accumulation
CDT Phase 1
- Treatment Phase
- Manual Lymph Drainage
- compression bandaging
- primarily outpatient based. session times range from 45 to 90 minutes:4 to 8 weeks
CDT Phase II
- Maintenance Phase
- Compression garments during the day, Bandaging at night
- Follow up visits (check up every 6 months)
What are the 5 major components of CDT?
- Skin care
- manual lymph drainage
- compression bandaging
- therapeutic exercise
- self care
General CDT contraindications
- acute infection
- cardiac edema
- acute DVT
- renal insufficiency
MLD of neck
- cardiac arrhythmias
- hypersensitivity of carotid sinus
- > 60 y/o
Contraindications of Bandaging
- arterial disease
- no compression with ABI < 0.8
What conditions require regular skin checks?
- Diabetes
- Lymphedema
MLD is used to?
- stimulate superficial lymphatic vessels to remove excess interstitial fluid and re-routes lymph flow
Effects of MLD
- increase movement of lymph and interstitial fluid
- increase in transport capacity of lymph collectors
- increase in lymphangio activity
- increase in macrophage activity
- soothing, analgesia benefits to patient
what do we use for effective gradient compression?
- short stretch bandages and foam
Compression gradient
- greatest distally and less proximally
Why do we want to use short stretch bandage?
- keep the patient moving, muscle contractions increase interstitial fluid pressure to move fluid out of congested areas
Benefits of Compression Wrapping
- prevents fluid refill into the tissues
- break down protein in fibrotic tissue
Law of Laplace
- the smaller the radius of the limb segment, the greater is the pressure applied by the bandage
Which bandage can stretch from resting length?
- Long Stretch (ACE)
Stretch > 140% of resting length
Function of short stretch bandage
- Edema management
Function of long stretch bandage
- Immobilization, limb shaping
Compression Garments are initiated when?
- when maximal volume reduction has occurred after phase I CDT
Gradient Compression Garments Precautions / Contraindications
- decreased sensation
- open wounds
- infection
Purpose of Compression Garments
- compensates for elastic insufficiency of skin after reduction
- Maintain volume reduction
Gradient Compression levels
<15mmHg: general leg health
20-30mmHg: UE lymphedema
30-40mmHg: LE lymphedema
40-50 mmHg: LE Lymphedema
Compression garments are contraindicated for?
- patients with congestive heart failure
Therapeutic Exercise Sequence
- Proximal to distal
Inflation/deflation time for Compression pumps
3:1
80-100s on: 25-35s off
Compression Pumps Inflation pressure
- upper extremity 30-60mm/hg
- lower extremity 40-80mm/hg
Lymph node transplant
- transplantation of superficial lymph nodes from an uninvolved area together with the vascular supply to the side of lymphadenectomy
lympho-venous bypass
- lymph vessels are connected to veins to improve lymph flow
Liposuction
- can be used to reduce excess fat deposition
Medications
- Diuretics
- Benzopyrones
When did Lymedema Treatment Act “LTA” take effect?
1/1/2024
