Lymphedema Prevention Tips

18 Steps to Prevention Revised:
Lymphedema Risk-Reduction Practices

By Saskia R.J. Thiadens, RN

It was in 1990 when I wrote the 18 Steps to Prevention for upper and lower limbs. Since that time, these guidelines have been widely used in doctor's offices, breast centers, hospitals, support groups, and publications around the country and the world. Without evidenced-based data, it has been and continues to be difficult to support and justify these Steps. The Medical Advisory committee (MAC) of the NLN came to the realization that this document needed to be strengthened and updated, which is a sign of progress in the world of lymphology. Because we do not know all the complex and interactive factors placing an individual at risk for lymphedema and, therefore, cannot totally prevent its occurrence based on our current level of knowledge, we focus on reducing risk of occurrence based on our best knowledge. Over the last 15 years, we have developed tremendous insight of the lymphatic system and I am pleased to deliver this new NLN Position Paper on Risk Reduction guidelines. Please update your educational materials and protocols immediately and alert your colleagues, as well. Thank you.

I. Skin Care - Avoid trauma/injury and reduce infection risk

1. Keep extremity clean and dry.
2. Apply moisturizer daily to prevent chapping/chaffing of skin.
3. Attention to nail care; do not cut cuticles.
4. Protect exposed skin with sunscreen and insect repellent.
5. Use care with razors to avoid nicks and skin irritation.
6. If possible, avoid punctures such as injections and blood draws.
7. Wear gloves while doing activities that may cause skin injury (i.e., gardening, working with tools, using chemicals such as detergent).
8. If scratches/punctures to skin occur, wash with soap and water, apply antibiotics, and observe for signs of infection (i.e. redness).
9. If a rash, itching, redness, pain, increased skin temperature, fever or flu-like symptoms occur, contact your physician immediately.

II. Activity / Lifestyle

1. Gradually build up the duration and intensity of any activity or exercise.
2. Take frequent rest periods during activity to allow for limb recovery.
3. Monitor the extremity during and after activity for any change in size, shape, tissue, texture, soreness, heaviness or firmness.
4. Maintain optimal weight.

III. Avoid limb constriction

1. If possible, avoid having blood pressure taken on the at risk arm.
2. Wear loose fitting jewelry and clothing.

IV. Compression Garments

1. Should be well-fitting.
2. Support the at risk limb with a compression garment for strenuous activity (i.e. weight lifting, prolonged standing, running).
3. Wear a well-fitting compression garment for air travel.

V. Extremes of Temperature

1. Avoid exposure to extreme cold, which can be associated with rebound swelling, or chapping of skin.
2. Avoid prolonged ( > 15 minutes) exposure to heat, particularly hot tubs and saunas.
3. Avoid immersing limb in water temperatures above 102° F.

VI. Additional practices specific to lower extremity lymphedema

1. Avoid prolonged standing or sitting.
2. When possible, avoid crossing legs.
3. Wear proper, well-fitting footwear.

© July 2005 National Lymphedema Network. Permission to print out and duplicate this page in its entirety for educational purposes only, not for sale. All other rights reserved. For more information, contact the NLN: 1-800-541-3259

(Reprinted with permission from the National Lymphedema Network)

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