Minimizing the Risk of Infections
Any cut or lesion in the skin of a lymphedematous (swollen) arm or leg will allow bacteria to enter tissue. Extra care should be taken not to bump, cut, bruise or scratch the limb.
Insect Bites & Pet Scratches
Use insect repellent on areas where insect bites are likely.
Housework, Gardening, Sewing
Loose rubber gloves should be worn when washing dishes. This includes cleaning the dishes off prior to putting them in the dishwasher. You should also wear gloves household cleaning chores, as chemical cleaners can cause skin irritation, or potential skin openings.
When gardening, wear gloves to protect the skin from scratches and thorns. Since gardening gloves tend to get dirty inside as well as outside, either wash the gloves inside-out after each use, or wear washable cotton gloves inside the gardening gloves and wash these at the end of the day.
Use a thimble when sewing if the dominant hand is at risk, or a finger guard if the non-dominant hand is at risk.
If you wish to remove hair from under your arms or on the legs, use an electric razor that is properly maintained (new heads as needed). Do not use a safety razor or cream hair removers. They are more likely to cause skin openings.
Use caution cutting nails. Cuticles should be kept moist with appropriate creams and pushed back. Never cut the cuticles. Clip toenails with clippers, not scissors, and cut straight across.
Blood Tests, Injections
Never allow anyone to puncture the skin of the swollen limb or the limb at risk of lymphedema. This includes blood tests, injections and finger sticks.
If having surgery, be sure the anesthesiologist knows about the swollen limb or the limb at risk of lymphedema.
Cleanliness and Skin Care
Keep the limb very clean. Wash daily and dry well. Use mild soap and warm (not hot) water. This will help to avoid a build-up of lotion. Wash twice daily if activities indicate. Dry well in all creases between fingers and toes. In the case of deep skin folds, rubbing alcohol may be used to promote dryness, or a hair dryer set on “cool” may be used to thoroughly dry the skin. Damp skin folds are prone to fungal infections. Regular use of an anti-fungal powder or lotion is recommended for the feet in cases of lower extremity lymphedema, especially if the feet are moist.
Avoid soaking the extremity in a tub.
Wear a clean stocking/sleeve daily.
Inspect your body on a daily basis. Look for dry skin, blisters, cracks, and calluses that allow bacteria to grow and infections to form. Recognize any changes in skin color/or temperature.
If no sores are present and the skin is dry, use non-perfumed lotion with low PH, lanolin-based ointments or cocoa butter at bedtime.
Do not bathe or shower when wearing bandages UNLESS the bandage is covered with a large plastic bag.
Sponge bathing is necessary to avoid dampening the bandage.
Treatment, Locker Rooms, Restrooms
Avoid going barefoot at all times.
Do not walk barefoot on floors of the treatment rooms, public restrooms, and locker rooms of exercise facilities.
Shake out shoes before wearing them to make sure there is nothing inside that might irritate the feet.
Only use public swimming pools that have been well treated. Have pool management check the water quality prior to use. Always wear rubber soled, water resistant shoes when swimming in the ocean.
Use SPF 30+ sunscreen on the limb when swimming or when outdoors. Remember that burns are possible even on a cloudy day, and daily use of a sunscreen is necessary year round. If traveling for a long time in a car or boat, drape a white shirt over the lymphedematous limb if it is in the sun. Do NOT allow the limb to get sunburned.
Avoid Cooking Burns
Use extra long, good quality oven mitts to protect hands and forearms from cooking burns. Use care when frying foods, as oil splashes can cause skin openings. Be careful of steam burns from microwave foods as well.
Avoid Tight Objects
Constricting items will worsen the weakened circulatory/lymph system.
Rings, watches, and bracelets should be loose if worn on an arm or hand at risk. If the jewelry is tight, wear on the unaffected limb.
Wear a purse on the unaffected shoulder and remove non-essential items so the purse is lighter. Use wide straps for purses/handbags. Avoid back pack type carrying cases.
Clothing should never bind at the waist, groin, chest, underarm, wrist or ankle.
Avoid clothing with tight elastic.
Clothes, including underpants/panties, girdles or pantyhose should be loose around the waist and thighs. There should be no redness or indentation when removed.
If clothing is too tight, lymphatic drainage is restricted and a “tourniquet” effect occurs.
Avoid wearing tight belts. (Suspenders are an alternate way to keep trousers up).
When wearing a bra, it should not be too tight around the ribs or over the shoulder. You should wear a good support bra particularly to prevent edema from forming in the other breast. The bra should not be so tight that it cuts in either the ribs or at the shoulders. A wider shoulder strap is recommended, and if necessary, place some foam padding under the shoulder strap and the lower support area. There should be no redness or indentation when the bra is removed.
Following a mastectomy, use the lightest weight prosthesis. Using a heavy breast prosthesis after a mastectomy may put too much pressure on the lymph nodes in the axillary region. Pressure slows down and interrupts the lymphatic pathways, preventing fluid from flowing through and out the lymphatic system. If the prosthesis is large, request that it be lightweight.
Shoes & Stockings
Wear well-fitting shoes to avoid skin breakdown or pressure points. Tight shoes can create ulcers.
Break new shoes in slowly.
Always wear a sock or stocking with shoes. If the foot is swollen, a wide shoe or slipper may be necessary. Wear comfortable, adjustable lace-ups that provide cushioning while walking. Sneakers are good, comfortable shoes to wear.
Blood Pressure Measurements
The inflated blood pressure cuff further limits the circulation in an arm that already has poor circulation. Have blood pressure checked in the unaffected arm.
Avoid crossing the legs (pressure may damage the vessel walls as well as obstruct blood flow).
Excessive Heat or Cold
Heat increases blood flow through the tissues. Sudden temperature changes cause stress on the weakened system. Keep the limb as cool as possible in hot weather (If necessary, install air conditioning).
Steam Baths, Hot Showers, Hot Tubs, Jacuzzis & Saunas
Shower and bath water should be lukewarm or close to body temperature. It should never be so hot that it reddens the skin. Test bath water with the unaffected extremity. Personal jacuzzis may be used if the temperature is moderate.
Exercise moderately in the morning or afternoon, avoiding the heat of the day. During exercise, make sure to adequately warm-up, cool-down and take periodic rests.
Heat Lamps, Heating Pads & Tanning Booths
Do not use
Do not use
Avoid Muscle Strain
Strain on an extremity with an already compromised circulation can lead to increased edema.
Use the affected arm or leg as normally as possible. Limping and favoring the limb leads to abnormal muscle use patterns and potential muscle strain.
Avoid lifting or moving heavy loads. Beware of heavy grocery bags or luggage. Try not to carry groceries with the affected forearm and keep the bags as light as possible. Remember, the groceries still have to be transported from the shopping cart to the car and from the car to the home.
Recognizing Cellulitis/Lymphangitis (Infection)
For all lymphedema and chronic venous insufficiency patients, it is extremely important to avoid infection. The following information may be helpful in warding off potentially dangerous infections of the affected limb(s).
Precautions are designed to reduce the risk of developing serious infections in the affected limb. Perform a daily “skin check”, paying close attention to skin folds and areas with reduced sensation. This is best performed daily before bathing. Look for cuts, abrasions, insect bites or any other signs of damaged skin. Inspect nails for cracked or torn cuticles, hang nails or ingrown toenails. All of these skin openings are potential sources for infection. Preventative measures include cleaning the opening on the skin, applying an antibacterial cream to the area and covering it with a bandage.
SIGNS AND SYMPTOMS
The onset of early-infection may vary, but often patients first notice:
- A rash and itching on the affected limb
- Increased swelling
- Increased temperature
- Heavy sensation in the limb
- Pain radiating in the arm pit or groin
- Chills and high fever
- Unusual color, amount or odor of drainage from the wound
N0TE: Consult your physician immediately, should any of the above symptoms occur.
Immediately discontinue all lymphedema treatment (compression stocking/sleeve, compression pump therapy) immediately at onset of infection and contact your physician. The following instructions may be given:
- Increase fluid intake
- Watch for changes in the limb
- Monitor body temperature
- Stay out of the direct sun
The physician may suggest having an antibiotic on hand at all times. Signs of infection, such as chills, fever, local tenderness, and/or ascending redness with streaks along the lymphatic limb, should be followed by immediate antibiotic administration.
OTHER IMPORTANT TIPS
- Patients who undergo surgery should take extra precautions and should inquire about the use of antibiotics prior to surgery.
- Patients who have the flu, a cold, allergies, or a high level of stress in their line are often more susceptible to developing infections as a result of the weakened lymphatic or circulatory system.
Please remember – you are responsible for your own health. Be alert to any changes that could worsen your condition.
Exercise is important because lymphatic drainage is improved by tissue compression of muscular contractions. During exercise, the joints and muscles work together to squeeze the soft tissue and the lymph fluid travels proximally to the vascular system.
Exercise moderately. Begin any exercise program slowly, increasing gradually and monitoring the limb carefully for changes in the swelling. Do not make the limb ache with tiredness.
Exercise promotes weight control. Try to keep your weight in the “normal” range.
Drink extra fluid if exercising in the heat or in low humidity.
If possible, wear a compression stocking or sleeve while exercising. A stocking or sleeve is not necessary if exercising in the water.
RUBBING, SCRUBBING, PUSHING, PULLING
Regular household chores and gardening are O.K. if done in moderation avoiding undue stress or strain.
Light resistance training can be beneficial. Physical exertion increases circulation through muscle and tissue, while muscle contraction helps to move lymphatic fluid out of the extremity and towards the heart.
WALKING, SWIMMING, CYCLING & ISOMETRICS
These are great forms of exercise. While strenuous exercise is not for everyone, walking is generally safe for all.
The following will help improve the circulation in the affected extremity(ies).
- Move your legs often, even when lying in bed.
- Try not to stand or sit in one position for prolonged periods of time.
- If standing for long periods, rise up on your toes several times an hour or shift your body weight from foot to foot.
- If sitting for long periods, prop the affected leg up on a chair or stool.
- If possible, stand and move about frequently.
- On long car trips, stop every two hours for brief walks to exercise the legs.
A healthy nutritional plan low in fat, low in sodium and high fiber is suggested.
Limit fat and cholesterol intake by eating few red meats, fried foods, eggs and dairy products. Use substitutes for eggs and dairy products.
Use sparingly while cooking and try to avoid adding any more salt at the table.
Try using other spices such as garlic and lemon.
The main sources of fiber are: raw fruits, especially those with skin and seeds; vegetables such as celery, corn and lima beans; and whole grain breads and cereals.
- A balanced diet is best.
- Avoid Overeating.
Elevate the lymphedematous limb(s) whenever possible. Efforts should be made to elevate the limb above the level of the heart. This will promote drainage of excess fluid out of the extremity.
Elevate the leg(s) for 10-15 minutes several times a day. The ankle(s) should be higher than the knees, which should be higher than the heart.
- While working, set aside rest periods for leg elevation.
- Flexing the knee is permissible.
- Elevate the legs while sleeping by raising the foot of the bed on 8 inch blocks.
- Sit in a recliner (Position the recliner so the head is lower than the heart.
- Lie on the floor with the legs in a chair. If the legs cannot be elevated using this technique, try a foam rubber block or several large pillows. Do not place the pillow(s) under the knee.
- Lie on the floor with legs up against the wall.
Elevate the arm(s) for 10-15 minutes several times a day. The hand should be higher than the elbow, which should be higher than the heart.
- Prop the affected arm up on several pillows while sleeping.
- A wedge can be used to elevate the arm while sitting or sleeping.
- The back of the sofa or couch can be used to support and elevate the arm.