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Lymphedema

Lymphedema

Lymphedema is a collection of fluid that causes swelling (edema) in the arms and legs.

  1. Unna Boot

    An Unna boot is a special dressing of inelastic gauze impregnated with zinc, glycerin, or calamine that becomes rigid when it dries. It is used for managing venous leg ulcers and lymphedema in patients who are ambulatory. When the patient… Read more…

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  2. Positive Stemmer’s sign yields a definitive lymphedema diagnosis in 10 seconds or less

    By Robyn Bjork, MPT, CWS, WCC, CLT-LANA In a busy wound clinic, quick and accurate differential diagnosis of edema is essential to appropriate treatment or referral for comprehensive care. According to a 2010 article in American Family Physician, 80% of… Read more…

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  3. Compression therapy for chronic venous insufficiency, lower-leg ulcers, and secondary lymphedema

    By Nancy Chatham, RN, MSN, ANP-BC, CCNS, CWOCN, CWS, and Lori Thomas, MS, OTR/L, CLT-LANA An estimated 7 million people in the United States have venous disease, which can cause leg edema and ulcers. Approximately 2 to 3 million Americans… Read more…

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  4. Clinical Notes

    2012 guideline for diabetic foot infections released Foot infections in patients with diabetes usually start in a wound, most often a neuropathic ulceration. So clinicians can better manage diabetic foot infections, the Infectious Diseases Society of America (IDSA) published “2012… Read more…

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  5. Chronic venous insufficiency with lower extremity disease: Part 2

    By Donald A. Wollheim, MD, WCC, DWC, FAPWCA To begin appropriate treatment for chronic venous insufficiency (CVI), clinicians must be able to make the correct diagnosis. Part 1 (published in the March-April edition) described CVI and its presentation. This article… Read more…

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  6. Lymphedema 101 – Part 2: Treatment

    By Steve Norton, CDT, CLT-LANA Editor’s note: Part 1 of this series, published in the September-October issue, discussed lymphedema pathology and diagnosis. This article, Part 2, covers treatment. Traditional treatment approaches Traditionally, lymphedema treatment has been approached without a clear… Read more…

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  7. Skin problems with chronic venous insufficiency and phlebolymphedema

    Dermatologic difficulties: Skin problems in patients with chronic venous insufficiency and phlebolymphedema By Nancy Chatham, RN, MSN, ANP-BC, CWOCN, CWS; Lori Thomas, MS, OTR/L, CLT-LANA; and Michael Molyneaux, MD Skin problems associated with chronic venous insufficiency (CVI) and phlebolymphedema are… Read more…

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  8. Chronic venous insufficiency with lower extremity disease: Part 1

    By Donald A. Wollheim, MD, WCC, DWC, FAPWCA Chronic venous insufficiency (CVI) is the most common cause of lower extremity wounds. The venous tree is defective, incapable of moving all the blood from the lower extremity back to the heart.… Read more…

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  9. Lymphedema 101 – Part 1: Understanding the pathology and diagnosis

    By Steve Norton, CDT, CLT-LANA Lymphedema is characterized by regional immune dysfunction, distorted limb contours, and such skin changes as papillomas, hyperkeratosis, and increased girth. The condition may involve the limbs, face, neck, trunk, and external genitals; its effects may… Read more…

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  10. Clinical Notes: Radiation & Lymphedema, Decline in Diabetic Foot Ulcers

    Radiation and lymphedema Radiation therapy doesn’t increase the incidence of lymphedema in patients with node-negative breast cancer, according to research presented at the American Society for Radiation Oncology’s 56th Annual Meeting held this fall. The study consisted of a secondary… Read more…

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  11. Bedside ankle-brachial index testing: Time-saving tips

    By Robyn Bjork, MPT, CWS, WCC, CLT-LANA A hot flush of embarrassment creates a bead of sweat on my forehead. “I’ve got to get this measurement,” I plead to myself. One glance at the clock tells me this bedside ankle-brachial… Read more…

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  12. Clinical Notes : Diabetes, medical honey, silver dressings, clostridium

    Guidelines for optimal off-loading to prevent diabetic foot ulcers  “The management of diabetic foot ulcers through optimal off-loading,” published in the Journal of the American Podiatric Medical Association, presents consensus guidelines and states the “evidence is clear” that off-loading increases healing of… Read more…

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  13. Clinical Notes

    Diabetes carries high economic burden According to a study published in Diabetes Care, the economic burden associated with diagnosed diabetes (all ages) and undiagnosed diabetes, gestational diabetes, and prediabetes (adults) exceeded $322 billion in 2012, amounting to an economic burden… Read more…

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  14. Clinical Notes: Moldable Skin Barrier, hypoglycemia, diabetic food ulcers

    Moldable skin barrier effective for elderly patients with ostomy A study in Gastroenterology Nursing reports that compared to a conventional skin barrier, a moldable skin barrier significantly improves self-care satisfaction scores in elderly patients who have a stoma. The moldable skin barrier also caused less irritant dermatitis… Read more…

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  15. Clinical Notes: Aspirin, Skin Infections, NPWT surgical incisions

    Aspirin inhibits wound healing A study in the Journal of Experimental Medicine describes how aspirin inhibits wound healing and paves the way for the development of new drugs to promote healing. The authors of “12-hydroxyheptadecatrienoic (12-HHT) acid promotes epidermal wound… Read more…

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  16. Clinical Notes: Pressure Injury Prevention, Diabetes, LIV

    Incidence density best measure of pressure-ulcer prevention program According to the National Pressure Ulcer Advisory Panel (NPUAP), incidence density is the best quality measure of pressure-ulcer prevention programs. Pressure-ulcer incidence density is calculated by dividing the number of inpatients who develop… Read more…

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  17. Clinical Notes: Pressure-Ulcer Data, Diabetic Foot Ulcers, IFG & HbA1c

    Hospital pressure-ulcer comparison data not accurate Performance scores for rates of hospital-acquired pressure ulcers might not be appropriate for comparing hospitals, according to a study in the Annals of Internal Medicine. “Hospital report cards for hospital-acquired pressure ulcers: How good… Read more…

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  18. Clinical Notes: Modified Braden Risk Score, dialysis patients, plantar

    Modified Braden risk score proposed A study in Ostomy Wound Management states the risk classification of patients using Braden Scale scores should comprise three (rather than five) levels: high risk, with a total score ≤11; moderate risk, with a total… Read more…

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  19. Clinical Notes

    Diabetes ‘ABC’ goals improve, but work remains The number of people with diabetes who are meeting the ABC goals—hemoglobin A1C, blood pressure, and LDL cholesterol—has risen significantly in recent years, according to a study published by Diabetes Care. Patients meeting… Read more…

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  20. Clinician Resources

      Here are resources that can help you in your busy clinical practice by giving you information quickly. Pressure ulcer resources Instead of searching through Google or another search engine for pressure ulcer resources, start with this comprehensive list on… Read more…

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  21. Clinical Notes: Low BMD, CKD, hypoglycemia, HBOT

    Low BMD common after ostomy Low bone mineral density (BMD) is common in patients with inflammatory bowel disease who have a stoma placed, according to “Frequency, risk factors, and adverse sequelae of bone loss in patients with ostomy for inflammatory… Read more…

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  22. Clinical Notes

    New wound-swabbing technique detects more bacteria The new Essen Rotary swabbing technique takes a few seconds longer to perform than traditional techniques, but improves bacterial count accuracy in patients with chronic leg ulcers, according to a study published by Wounds… Read more…

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  23. Clinician Resources: Intl Ostomy Assoc., Substance Use Disorder

    Take a few minutes to check out this potpourri of resources. International Ostomy Association The International Ostomy Association is an association of regional ostomy associations that is committed to improving the lives of ostomates. Resources on the association’s website include:… Read more…

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  24. Clinical Notes: biofilm, bariatric surgery, statins and more

    Management of biofilm recommendations The Journal of Wound Care has published “Recommendations for the management of biofilm: a consensus document,” developed through the Italian Nursing Wound Healing Society. The panel that created the document identified 10 interventions strongly recommended for clinical practice; however, panel members noted that, “there… Read more…

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  25. Providing evidence-based care for patients with lower-extremity cellulitis

    By Darlene Hanson, PhD, RN; Diane Langemo, PhD, RN, FAAN; Patricia Thompson, MS, RN; Julie Anderson, PhD, RN; and Keith Swanson, MD Cellulitis is an acute, painful, and potentially serious spreading bacterial skin infection that affects mainly the subcutaneous and… Read more…

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  26. Clinical Notes: Debridement, Optimal Wound Healing, Diabetes, Sacral Wounds

    Frequent debridement improves wound healing A study in JAMA Dermatology reports that fre­quent debridements speed wound healing. “The more frequent the debridement, the better the healing outcome,” concludes “Frequency of debridements and time to heal: A retrospective cohort study of… Read more…

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  27. Clinical Notes: diabetes, LMW heparin, dressings, lymphedema

    Factors affecting medication adherence in patients with diabetes identified Factors associated with better adherence to antidiabetic medications taken by patients with diabetes include older age, male sex, higher education, higher income, use of mail-order vs. retail pharmacies, primary care vs.… Read more…

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  28. Clinical Notes: Ischemia, Breast Cancer, ICU Patients

    Critical limb ischemia may not increase mortality risk in patients with diabetes Diabetic patients with critical limb ischemia (CLI) who are assessed quickly and treated aggressively do not have an increased risk of long-term cardiac mortality, according to a study… Read more…

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  29. A collaborative approach to wound care and lymphedema therapy: Part 1

    By Erin Fazzari, MPT, CLT, CWS, DWC Have you seen legs like those shown in the images below in your practice? These images show lymphedema and venous stasis ulcers, illustrating the importance of collaboration between clinicians in two disciplines: lymphedema… Read more…

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  30. Lymphedema and lipedema: What every wound care clinician should know

    Imagine you have a health condition that affects your life every day. Then imagine being told nothing can be done about it; you’ll just have to live with it. Or worse yet, your physician tells you the problem is “you’re just fat.” Many people with… Read more…

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  31. Clincal Notes: Analysis, Osteomyelitis, sickle cell, maggot

    Value of systematic reviews and meta-analyses in wound care “Systematic reviews and meta-analyses—literature-based recommendations for evaluating strengths, weaknesses, and clinical value,” in Ostomy Wound Management, discusses evidence-based practice and how systematic reviews (SRs) and meta-analyses (MAs) can help improve management… Read more…

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  32. Clinical Notes: Wound Photography, Lymphedema, GI Complaints

    Wound photography may motivate patients Having patients view photographs of their wounds can motivate them to become more involved in managing those wounds, according to a study in International Wound Journal, particularly when wounds are in difficult-to-see locations. In the… Read more…

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  33. Learning to love your job

    By Joan C. Borgatti, MEd, RN The alarm clock goes off too early, and you jump-start the day with a cup of coffee and a short stack of reasons why you hate your job. Sound familiar? Although you can’t expect… Read more…

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  34. Clinical Notes

    Mild compression diabetic socks safe and effective for lower extremity edema Diabetic socks with mild compression can reduce lower extremity edema in patients with diabetes without adversely affecting arterial circulation, according to a randomized control trial presented at the American… Read more…

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  35. Clinical Notes: Healing SCI Patients, antiseptics on mahout, diabetes

    Electrical stimulationElectrical stimulation and pressure ulcer healing in SCI patients A systematic review of eight clinical trials of 517 patients with spinal cord injury (SCI) and at least one pressure ulcer indicates that electrical stimulation increases the healing rate of pressure ulcers. Wounds with electrodes overlaying the wound… Read more…

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  36. Clinical Notes: diabetic foot osteomyelitis, BIA, footwear

    Antibiotics and conservative surgery yield similar outcomes in patients with diabetic foot osteomyelitis A study in Diabetes Care finds that anti­biotics and surgery have similar outcomes related to rate of healing, time of healing, and short-term complications in patients who… Read more…

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  37. Clinician Resources: Pressure-Injuries, Ostomy, Lymphedema, Delirium

    Here is a round-up of resources that you may find helpful in your practice. New illustrations for pressure-injury staging The National Pressure Ulcer Advisory Panel (NPUAP) has released new illustrations of pressure injury stages. You can download the illustrations, which include normal Caucasian and non-Caucasian skin… Read more…

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  38. NYU docs use machine learning

    Lymphedema causes unsightly swelling in the arms and legs. But researchers Mei Fu and Yao Wang have an idea for catching early symptoms sooner. Researchers at NYU’s Tandon School of Engineering have teamed up with those from the university’s Rory Meyers College of… Read more…

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  39. Stand up to bullies

    By: Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS At some point, most of us have encountered a bully—most commonly when we were kids. You might think that as we get older, bullying wouldn’t be a problem we have to deal… Read more…

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  40. Clinical Notes

    Study finds less-invasive method for identifying osteomyelitis is effective Researchers have found that using hybrid 67Ga single-photon emission computed tomography and X-ray computed tomography (SPECT/CT) imaging combined with a bedside percutaneous bone puncture in patients with a positive scan is… Read more…

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  41. When you can’t rely on ABIs

    By Robyn Bjork, MPT, CWS, WCC, CLT-LANA One of the worst fears of a wound care clinician is inadvertently compressing a leg with critical limb ischemia—a condition marked by barely enough blood flow to sustain tissue life. Compression (as well… Read more…

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  42. A collaborative approach to wound care and lymphedema therapy: Part 2

    By Erin Fazzari, MPT, CLT, CWS, DWC Have you seen legs like these in your practice? These legs show lymphedema and chronic wounds before treatment (left image) and after treatment (right image) with complex decongestive therapy (CDT)—the gold standard of… Read more…

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  43. Role of rehab in wound care

     By Bill Richlen, PT, WCC, DWC, and Denise Richlen, PT, WCC, DCCT How many times have you heard someone say, “I didn’t know PTs did wound care”? Statements like this aren’t uncommon. The role of physical therapists (PTs), occupational therapists,… Read more…

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