SMASAC Short Life Working Group on Lymphoedema - Lymphoedema Care in Scotland, Achieving Equity and Quality

Lymphoedema in Primary Care - Quick Guide

People at risk include:

• Those with recurrent cellulitis
• Inflammatory joint disease
• Chronic skin problems
• Trauma involving lymph nodes
• Obesity
• Family history of lymphoedema
• Cancer and its treatment
• Those with limited mobility.

Health care professionals should offer oral and written information to people at risk of developing lymphoedema on how to minimise their risk. Information should include:

• Good skin care
• Identifying infection
• Physical activity
• Weight management and a balanced diet.

People at high risk and their carers should be offered written and oral information on how to recognise the common signs and symptoms of lymphoedema:

• Swelling (is often presenting in one limb)
• Change in sensation (feels heavy, tight, full, stiff)
• Skin change (tight, stretched).

Primary health care professionals should be able to recognise the signs and symptoms of lymphoedema in order to differentiate diagnosis from recurrence of malignancy, deep venous thrombosis, or cardiac failure. If lympoedema is suspected early referral to a health care professional with specialist knowledge of lymphoedema for diagnosis, assessment and treatment is recommended.

On confirmation of diagnosis the following READ codes are recommended:

• G860. lymphoedema post mastectomy
• G861. other lymphoedema.

Following assessment from a health care professional with specialist knowledge of lymphoedema the treatment and support for self management can be provided in primary care:

• Psychosocial support
• Self monitoring of lymphoedema signs and symptoms
• Encouraging daily skin care, limb elevation and lymphatic drainage as taught by health care professional with specialist knowledge of lymphoedema
• Monitoring compression treatment and prescribing.

Cellulitis is a common complication and needs to be assessed and treated vigorously to prevent further lymphatic damage and worsening of lymphoedema. Guidelines on treatment are available from http://www.thebls.com/consensus.php.

Lymphoedema is a long term condition requiring primary care practitioners to have appropriate knowledge and skills so as to support people and their carers to self manage. Access to a practitioner with specialist knowledge is required if the condition deteriorates requiring reassessment.

GP Notebook http://gpnotebook.co.uk/homepage.cfm offers a useful summary of diagnosis and management in primary care.