Last Updated Mar 2012
More than 2 million Americans suffer from lymphedema, a notoriously debilitating progressive condition characterized by persistent swelling, typically in the arms or legs. The underlying problem is a blockage of the lymph passages resulting in an abnormal accumulation of interstitial fluid, which may be caused by several things: injury, infection, radiation therapy and even surgery.
Although there is no known cure for lymphedema, the disease can be controlled through diligent care. A combination of several treatment methods, along with patient education, can go a long way toward restoring mobility and range of motion; decreasing swelling; preventing infection; and improving overall patient quality of life. One of the key methods for lymphedema management is the use of compression garments.
Compression Garments
When edema has stabilized, compression garments are necessary to maintain decongestion. Lymphedema patients eventually graduate from bandages into elastic compression garments as the limb reaches a more decongested state. Many potential problems and needs must be met and overcome in order to arrive at a comfortable yet supportive daily garment solution.
A few basics to remember:
- Certification is required for measuring compression garments. If no certified clinician is available, a product representative can come to your facility to measure your patient.
- Because each individual is different, it is important to discern at the beginning of the treatment phase what is possible or impossible concerning garment fitting. This is done as you observe the patient's response to treatment, attitude, weight, aptitude, and physical limitations.
- Compression garments should be worn ten to 14 hours a day. They are made for daytime use only due to the increased risk of rolling and producing a tourniquet effect at night while the patient is sleeping. (Compression bandaging should be used at night instead.)
Choosing a Compression Garment
Making the decision to use off-the-shelf or custom-made compression garments depends on several factors: the severity of lymphedema, the ease of decongestion, the shape of the limb, and the cost.
A Word about Compression Class (CCL)
As with bandaging, lower pressure—20 to 30 mmHg for upper extremity (UE) lymphedema patients, 30 to 40 mm Hg for lower extremity (LE) lymphedema patients—is typically better tolerated. Higher-pressure hose should be prescribed only when it is known that the edema cannot be managed with lower pressures. This is particularly important to consider knowing that these patients will most likely be wearing garments lifelong.
- CCL I: 20-30 mmHg – Minimum compression for UE lymphedema; offers support but is not sufficient for LE lymphedema
- CCL II: 30-40 mmHg – Applicable for most stage 2 UE lymphedema conditions, minimum compression for LE lymphedema; offers support for LE CVI
- CCL III: 40-50 mmHg – Rarely used in UE lymphedema, applicable for most stage 2 LE lymphedema; minimum starting point for stage 3 lymphedema
Guidelines to Determine Correct Compression Class
- How much compression was required during the treatment phase to reduce the limb?
- Does the limb fluctuate much during pre-treatment times, as when bandages have been removed?
- Is the skin flaccid or is there extra hanging skin following a dramatic reduction?
- Has the patient tolerated the compression well? Is there any sign of intolerance to pressure such as pain or tissue breakdown?
- Can the patient apply the most appropriate compression class without undue struggle?
The Importance of Patient Education
Once the correct compression class has been determined, the appropriate garment style may be chosen for the patient (e.g. sleeve, gauntlet, hose) and a successful plan of care may be developed. This will often include the use of remedial exercises to strengthen the muscles.
Because patients must be able to manage their care at home for lymphedema treatment to truly be successful, it is especially important to educate them about all aspects of their care and treatment, particularly with regard to compression garments. As therapists we are in a unique position to help patients understand the correct usage of compression garments and other treatment methods to ensure optimal health outcomes.
To learn more about the care and treatment of patients with lymphedema, view our comprehensive online courses: Lymphedema Management Part 1: Overview and Assessment and Lymphedema Management Part 2: Treatment.
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