View
227
Download
1
Category
Tags:
Preview:
Citation preview
LYMPHEDEMA, VENOUS STASIS ANDTHE IMPORTANCE OF COMPRESSION
Timothy A. Hursh, MDMedical Director, Wound CareKindred Hospital San Antonio
Agenda for Today’s Discussion Physiology Diagnosis Clinical Presentation Treatment Case Examples
Physiology
Lymphedema (lymphatic obstruction) Swelling due to blockage of the lymph
channels Causes include
Infection with parasites (filariasis) Injury Radiation Surgery (mastectomy) Radiation Therapy Infection (cellulitis)
Physiology
Venous Stasis (aka Venous Insufficiency) Veins unable to help blood return to the
heart Causes include:
One or more deep leg veins are compromised “One-way-valves” either broken or missing
Risk factors include: increased age, history of leg DVT, female, increased height, pregnancy, obesity, prolonged sitting/standing
Diagnosis
Lymphedema CT or MRI Lymphangiogram Lymphoscintigraphy (radioactive tracing)
Venous Stasis Clinical diagnosis
Clinical Presentation
Lymphedema Swelling of arm/leg (acute or chronic) Staging
Stage 0 – lymph vessels damaged but are coping
Stage 1 – non-pitting edema, skin bounces back Stage 2 – pitting tissue, hardening of skin
begins & increased size Stage 3 – lymphatic channels closed from
fibrosis, limbs become swollen, hard
Clinical Presentation
Clinical Presentation
Venous Stasis Pts c/o dull aching, or cramping, limbs Itching or tingling Pain worse with standing, better with legs
raised Leg swelling Chronic changes include redness, varicose
veins, color changes around distal leg/ankles (bronzing), ulcers
Clinical Presentation
Treatment
Lymphedema Manual lymph drainage Compression wraps Light exercise (milking action of muscles) Skin care to decrease risk of infection Lymphedema pumps
Treatment
Venous Stasis Compression wraps No long periods of standing/sitting Exercise Wound care if wounds/ulcers
Treatment
Compression Wraps Class I 20-30 mmHg Class II 30-40 mmHg Class III 40-50 mmHg Class IV > 50 mmHg
Application should be done carefully from distal to proximal, midpoint overlapping, no wrinkles
Treatment
Common Types of Compression Wraps ALWAYS APPLIED DISTAL TO PROXIMAL Package instructions are not a
“suggestion” Spiral versus Figure 8 Dry versus medicated $$$ Can get costly very quickly
Are ACE wraps ok? Ensure patients have after hours
instructions
Profore
Unnas Boot
Case Example #1
68 yo male with 30 year Hx venous ulceration RLE
Obese, DM II, HTN Meds: metformin, diuretics (taken only
intermittently) Tx included: Unna boot healed earlier;
compression therapy at home but non-compliant so placed in compression stockings
Case Example #1
Case Example #1
Lived with ulcers for 4 years Finally consented to treatment with
combination of: Exercise (dorsiflexion emphasized) Alginate dressings covered with foam and
light compression
After 6 weeks of COMPLIANCE………
Case Example #1
Case Example #2
54 yo male with 5 yr Hx chronic lymphedema
PMH: Avascular necrosis of the hips, HTN, EtOH abuse, liver cirrhosis, chronic Hep C
Admitted for care of Stg 3 pressure ulcer of buttocks and newly developed ulcers of legs secondary to worsening lymphedema
Case Example #2
Jan 2012
Case Example #2
Treatment consisted of wound care, debridements PRN, manual massage, compression wraps, exercise
Discharged after 4 weeks care with plans for clinic follow-up and HHC for daily treatment of his lymphedema
Condition at discharge………...
Case Example #2
Feb 2012
Thank You for Attending!
Contact Information:
Tim Hursh, MD Kindred San Antonio Medical Director for Wound Care
(210) 616-0616
Timothy.Hursh@kindredhealthcare.com
Recommended