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NLN Position Papers: Risk Reduction, Diagnosis and Treatment, Exercise, Air Travel, Training, Breast Cancer Screening
Recent Featured Lymph e-Channel
It was in 1990 when I wrote the 18 Steps to Prevention for upper and lower limbs. Since that time, these guidelines have been widely used in doctor's offices, breast centers, hospitals, support groups, and publications around the country and the world. Without evidenced-based data, it has been and continues to be difficult to support and justify these Steps. The Medical Advisory committee (MAC) of the NLN came to the realization that this document needed to be strengthened and updated, which is a sign of progress in the world of Lymphology. Because we do not know all the complex and interactive factors placing an individual at risk for lymphedema and, therefore, cannot totally prevent its occurrence based on our current level of knowledge, we focus on reducing risk of occurrence based on our best knowledge. Over the last 15 years, we have developed tremendous insight of the lymphatic system and I am pleased to deliver this new NLN Position Paper on Risk Reduction guidelines. Please update your educational materials and protocols immediately and alert your colleagues, as well. Thank you.
I. Skin Care - Avoid trauma / injury to reduce infection risk
• 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 antibiotic cream or ointment,,
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 infection
II. Activity / Lifestyle
• Exercise regularly with a combination of activities incluing strength, flexibility and endurance exercises. Gradually build up the duration and intensity of any activity or exercise
• 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 firmness
• Maintain optimal weight
III. Avoid Limb Constriction
• If possible, avoid having blood pressure taken on the at-risk extremity
• Wear clothing and jewelry that is not too tight and does not have a tourniquet effect on the at risk part
IV. Compression Garments
• Should be well-fitting. Sleeves may need to be worn with a gauntlet to avoid constriction.
• May consider wearing a compression garment for strenuous activity
• Consider wearing a well-fitting compression garment for air travel
V. Extremes of Temperature
• Cover the at risk part with protective clothing when exposed to extreme cold, which can be associated with rebound swelling,
or chapping of skin
• Avoid prolonged (greater than 15 minutes) exposure to extreme heat, particularly hot tubs and saunas. In very hot climates, use a spray bottle to cool off and drink water frequently.
• Avoid placing limb in water temperatures above 102°Fahrenheit (38.9°Celsius)
VI. Additional Practices Specific to Lower Extremity Lymphedema
• Avoid prolonged standing, sitting or crossing legs. Change position frequently. If siting for extended periods, do ankle pumps.
• Wear proper, well-fitting footwear and hosiery. Clean inside of socks and slippers.
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.
© 2011 National Lymphedema Network (NLN). Permission to duplicate this handout as-is, in its entirety, for educational purposes only, not for sale. All other rights reserved. For reprint permission, please contact the NLN office at 415-908-3681 or nln@lymphnet.org.
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©2011 National Lymphedema Network. All rights reserved.
Permission to print and duplicate this page for personal and educational purposes only, not for sale. Reprint Permission Request Form (pdf format, 86kb). For more information, call 415-908-3681.