Minimizing the Risk of Infections
Any cut or break, even an insect bite, in the skin of a swollen arm or leg will provide an opening for bacteria to enter the body. If the body cannot fight off the bacteria, infection may ensue. Extra care should be taken not to bump, cut, bruise or scratch a lymphedematous limb.
Finger pricks, injections, and blood pressure cuffs should be avoided on the edematous limb. Healthcare providers should be informed of the patient’s lymphedema diagnosis prior to invasive procedures such as surgery.
Manicures and Pedicures
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.
Basic Hygiene and Skin Care
Keep the edematous limb very clean. Wash daily and dry well. Use mild soap and warm (not hot) water. Wash twice daily if activities indicate. Do not bathe or shower when wearing bandages unless instructed by your healthcare provider to use a waterproof barrier such as a plastic bag. Avoid soaking the extremity in a tub. Dry well in all creases between fingers and toes. Damp skin folds are prone to fungal infections; in the case of deep skin folds, a hair dryer set on “cool” may be used to help thoroughly dry the skin. 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. Check your skin daily for signs of any changes in skin color/or temperature, irritation, blisters, cracks and calluses that could allow bacteria to grow, increasing the risk for infection. 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.
Avoid tight, constricting clothing and jewelry as this may impede circulation or lymph flow. Clothing should never bind at the waist, groin, chest, underarm, wrist or ankle. 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 clean stocking/sleeve daily. 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-up shoes that provide cushioning while walking. Avoid going barefoot at all times. Clean out shoes before wearing them to make sure there is nothing inside that might irritate the foot.
Swimming and Sunbathing
Only use public swimming pools that have been well treated. If possible, have pool management check the water quality prior to use. Always wear rubber soled, water resistant shoes when swimming in the ocean. Avoid getting sunburn. 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 limb if it is in the sun.
Exercise is important because lymphatic drainage is improved by contraction of a muscle against an external pressure such as that applied by a compression garment. During exercise, the joints and muscles work together which creates a pressure difference in the tissue causing the lymph fluid to move into the lymphatic system, transporting it to healthy regions of the body where is can be processed normally. Exercise moderately. Begin any exercise program slowly, increasing gradually and monitor the limb carefully for changes in swelling. Always be aware of and assess symptoms of fatigue and heaviness of your affected limb during your exercise routine and modify as needed so you don’t experience an increase in swelling.
Elevate the 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. 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.