Compression:

How to Provide the Right Compression Treatment to Lymphedema Patients

Sponsored by: Juzo

• By Joseph Duffy
• Jul 01, 2010

Compression treatments are used to provide long-term maintenance for patients with vascular and lymphatic deficiencies. These treatments benefit a wide variety of people, from homecare patients to everyday people who are sedentary a good part of the day.

According to Claudia Boyle, medical compression specialist and owner of Van Driel’s Medical Support Wear Co., lymphedema patients differ from other compression garment wearers in two significant ways:

• The severity of their edema is often greater than that of other patients. This means higher compression and often firmer fabrics are required for lymphedema patients than for those suffering from other types of edema.
• Lymphedema patients are more likely to require another type of compression treatment to fully manage their limbs. Even a very firm compression garment worn during the day is often not enough to fully manage lymphedema, so additional treatments like compression pumps and nighttime compression garments are added to insure that tissue does not become fibrotic and that the circumferences of the limb are maintained.

“Lymphedema patients use compression to support the movement of lymphatic fluids, to maintain circumferences and to support the overall health of an affected limb,” says Boyle. “The goal of daytime compression treatment is to provide a lymphedema patient with enough compression to maintain the circumferences of the limb throughout the course of the day. If daytime compression treatments alone are not able to fully manage the edema or if the patient has hard, fibrotic tissue, then nighttime compression treatments are used to soften tissue and further reduce edema.”

Treatment

A qualified lymphedema therapist, who uses a combination of massage (manual lymph drainage) and compression wrapping, with short stretch elastic bandages to reduce the patient’s affected limb, provides the active phase of lymphedema therapy, says Boyle. At the end of the active phase the patient moves into the maintenance phase of therapy. The goal of the maintenance phase is to keep the limb healthy, which includes maintaining the circumferences of the limb, and keeping the tissue soft and free of infection. The right compression treatment for maintenance addresses the specific needs of each individual and has to take many factors into consideration including severity of the condition, fibrosis of the tissues, age of the patient and physical limitations.

“The best compression treatment for lymphedema patients is a good, supportive, manageable, non-binding garment in a compression grade that best matches the need of the affected limb,” says Boyle. For milder cases, she recommends a ready-to-wear stocking in 20-30mmHg or 30-40mmHg compression or a sleeve in 20-30mmHg. For more severe cases requiring higher compression, a custom made fl at knit material usually works best. “In the last couple of years, we have also seen some very effective new Velcro garments that can be used instead of, or in addition to, traditional elastic garments,” says Boyle.

Specific challenges facing lymphedema patients include the need for higher levels of compression and the application problems those compression levels bring, as well as the higher cost of the custom made compression garments they often require to manage their specific type of edema. They also have a greater tendency to develop fibrotic tissue and have a higher risk of infection of the affected limb than other wearers of compression garments.

Working with patients

Boyle offers the following tips to keep compression customers satisfied:

• Carry more than one brand of stockings. Find out what compression grade and type of stocking/sleeve the physicians in your area are prescribing and carry two options. No one brand accommodates all limbs perfectly. Plus if you have a little overlap of product you have a backup in brand B waiting if you run out of a particular product in brand A.
• Educate yourself. It is important to be very familiar with the products you are dispensing and to understand the differences in fabric, compression, and even how the shape of a limb compares to the shape of the product.
• Allow your customers to try their garments on before they leave your store.
• While this can be time consuming, it will prevent customers from taking home the wrong product, and it will allow you and your staff to see how the stockings you are selling fit the legs that are coming into your store.

This article originally appeared in the July 2010 issue of HME Business.