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"Observe the wonders as they occur around you. Don’t claim them. Feel the artistry moving through, and be silent."

RUMI

A brief guide to Oedema and Lymphoedema

Not all swollen limbs are due to lymphoedema and lymphoedema treatments are not necessarily effective or even indicated for oedema. In some situations e.g. venous thrombosis or severe heart failure, they may carry risk, and other more appropriate treatments are indicated.

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Limb Swelling due to:	Treatments to Consider:
Heart Failure	Diuretics Low pressure stockings (European compression class 1 or 2)*
Venous Obstruction**	Anticoagulants Stents Steroids (dexamethasone 8mg od for a week) Anti-tumour treatment Low pressure stockings (European compression class 1 or 2)* Half-leg bandaging / truncal massage if severe
Low albumin	High protein diet Whole blood transfusion Low pressure stockings (European compression class 1 or 2)* Half-leg bandaging / truncal massage if severe
Core Lymphoedema Treatment	1. Skin Care Regular Moisturising with simple emollients Chiropody / care with fingernails Advice about hygiene Fast track access to antibiotics at first sign of infection; consider leaving patient with a supply to start if needed Avoid injury (including injection / IV cannulation) to the affected limb 2. Exercise Normal use / gentle exercise 3. Truncal Massage Various techniques Self massage or family member may help Very gentle technique designed to move fluid to areas of normal drainage 4. Support / Compression TED stockings are not appropriate - compression garments for lymphoedema are specialist garments and need fitting professionally Need to be worn daily before starting to use the limb In an ill patient, who is too unwell to attend clinic it may be worth a trial of spironolactone 100-200mg daily with bandaging for comfort

* Available on GP prescription: see appendix 8 of the BNF and seek advice from your local lymphoedema service about prescribing
** If unresolved after twelve weeks, consider referral to lymphoedema service

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Important News

Important Changes in Cumbria Palliative Care Prescribing Practice

Cumbria is changing practice, from 1st April 2011.

The Area Prescribing Committee has recommended the following changes:

All strong opioids are to be prescribed by brand name
"Just in Case" prescribing is to be encouraged and promoted
Morphine is to replace diamorphine as the subcutaneous injectable strong opioid of choice for palliative care patients in Cumbria

21/03/2011

North Cumbria Pallative Care website

The award winning North Cumbria Palliative Care website continues to receive around 30,000 page views a year. This is 82 page views every single day of the year, 2,500 hits every month, without any publicity or advertising program.

1/3/2011