Innovative Management of Lymphedema, Edema and Wound Management in Home Health

Clinical Problem

 

4 patients are presented with swelling in their extremities; 2 of the patients have wounds. Pt.1- Lymphedema left leg 2 years. Pt. 2- Lymphedema both legs 4 years and weeping ulcers. Pt. 3- left arm/hand edema. Pt. 4- 3+ leg edema both legs 5 years and left leg wound.

 

 

Past Management

 

Pt.1- low dose hydrochlorothiazide, irregular with compression. Pt. 2- advanced wound care, light compression, offloading. Pt. 3- no past management. Pt. 4- hydrocolloid and gauze.

 

Current Clinical Approach

 

Extremities/wounds were initially cleansed. Polymeric membrane dressing (PMD) cavity filler in the wounds. PMD roll cut in pieces and placed around the affected extremities/ taped together. An outer layer absorbent pad applied over PMD roll to absorb drainage on lower extremities. Support hose applied. PMD standard dressing applied over the cavity filler, once the roll no longer needed and changed every 3 to 5 days until wound closure.

Patient Outcomes

 

Pt. 1- Left calf swelling reduced by 13 cm. Lymphedema returned 10 months later after radiation to the spine. Pt.2- swelling reduced in 2 weeks, ulcers closed 4 weeks later. No return of lymphedema for 4 months. Left leg swelling reduced by 20 cm, 21 cm on right leg. Support hose continued. Pt. 3 significantly visible fluid reduced after 24 hours with no return of edema. Patient died in hospice 4 weeks later unrelated to swelling. Pt. 4 reduced swelling to 1+ edema in 3 days and wound closed 2 weeks with no return of +3 edema in 3 months.

 

Conclusions

The use of PMDs resulted in dramatic outcomes managing lymphedema and edema. PMDs are now the standard of care.