by Sarah Gill
As a lymphoedema therapist your mind instantly start to tick over when you get the phone call from the patient who says:
- they have had lower leg lymphoedema for as long as they remember,
- have tried everything,
- have an open wound on the shin,
- legs are leaking,
- were given your name and thought they would give you a try.
The questions from you come thick and fast: e.g.
- when did you last have treatment?
- are you physically mobile?
- do you wear garments? If yes, how often?
- what community care do you receive?
- what is your current health condition?
- What other support mechanisms do you have in place?
- Do you sleep in a bed or a recliner chair?
- How long have the legs been leaking?
- Is the fluid clear or milky looking?
- Are you being treated for your wounds?
From this we can start to get a picture of what condition the patient may be in before we arrive at the appointment. Usually the leaking legs are their prime concern and they have some personal care assistant (PCA) allowance. If the patient has access to community nursing service, I ring the nursing group to inform that I will be visiting the patient for a consultation. ( If the patient does not have nursing assistance we start the process of initiating it through the local Council). I explain how I hope to develop a treatment protocol and ask if they would be willing to assist with some bandaging of the patient. Mobiderm with its ease of use, efficacy and training materials available, make it the ideal product to introduce. I then direct the nursing staff to the Mobiderm website where they can look the products I want to use.
The next step is to ascertain how compliant the patient will be with bandaging, we all know how busy community nursing staff are. At this point I will take in some of the bandages to show the patient and direct them to look at the Mobiderm website. I remind the patient that this will be a short-term plan and that if the nursing care is involved, they need to be compliant to the best of their abilities. The aim being to stem the leaking of the legs and then get them into a Mobiderm autofit thigh high or sock that the PCA will be able to assist with donning.
After I have demonstrated the Mobiderm bandaging protocol to the nurses, preferably to the team who will be working with the patient I direct them to the excellent Mobiderm training videos which they can use as a reference.
The treatment plan includes all aspects of patient care including skin care, wound care, exercise, occupation therapists to find a solution so the patient can sleep in a bed and new compression garments if required. Treatment commences with 5 days of bandaging for approximately 8 hours a day. The patient needs to have a family member or carer to remove the bandages for night-time. As the lymphoedema therapist you undertake the first day of bandaging on the Monday with the nurses following for the next 4 days. The patient rests on the weekend and then this protocol is repeated the following week. The patient’s wounds must be dressed, and absorption pads placed over areas of leaking. The patient is then transitioned into a Mobiderm autofit thigh high or sock which can be worn either daily or at night-time with compression wraps or garments worn in the daytime.
protocol for community nurses
8 hours per day if possible. Duration – dependent on case approx. 5 to 10 days. To be removed at night - time.
Mobiderm bandage (blocks 15 x 15 mm),
1 to 2 times 10cm Biflexideal short stretch
- Apply wound dressings or absorption pads of areas of lymphorrhea
- Apply 4 separate tubes of cotton bandage over the limb
- Cut one small pad of Mobiderm to cover the dorsum of the foot plus around malleolous if needed.
- Apply Mobiderm in a spiral to lower limb (ensuring no gaps)
- Apply Biflexideal short stretch bandage in a spiral with 50% overlay (include foot)
Post - treatment management
Tips for the therapist:
- Have plenty of Cotton short stretch tubes available so that the patient is able to have one set ready to use, one set washing and one set drying for the next day.
- Number each of the tubes with a permanent marker, 1, 2, 3, 4 to ensure that 4 layers go on.
- Write the names of the bandages on the bandages with permanent marker. Eg. Biflexideal
- Leave clear instructions in dot form in the bag wit the bandages and your contact number.
- BE very clear to the nursing staff and patient how long the bandaging protocol will take.
- The patient can get intensive lymphoedema treatment,
- By using available nursing care, I can reduce the direct cost of treatment to the patient.
- Nursing staff can usually only bandage from around 12pm onwards as they need to visit other patients for medications in the morning.