Complete Decongestive Therapy Overview

Manual Lymph Drainage

specialized soft tissue mobilization which stimulates lymphatic vessels
approach is a systematic, mild manual stretching to facilitate flow to main lymphatic vessels. Excessive manual pressure and stretching can strain and damage affected lymphatic vessels.

Stationary Circles	W14 MLD Brief lab: 5:31	Common around neck and face, but can be applied in most regions
Pumping	W14 MLD Brief lab begin at 5:44; and begin 9:17	Performed on extremity; distal to proximal
Scooping	W14 MLD Brief lab 10:14	Performed on the distal end of the extremity
Rotary	W14 MLD Brief lab 7:23	used for more flat areas, like trunk and abdomen

goals of MLD: increase lymphatic flow, increase extensibility of soft tissues, increase collateral lymph vessel formation
frequency of treatment is 2-5x/week for 2-8 weeks until limb size stabilizes/plateaus

Value: 1

Value: 4

compressive sleeve is applied to limb; can be single chamber or multiple chamber
chambers within sleeve are filled with air which provides distal-proximal external compression
Treatment time, on/off cycle, and amount of pressure is set by the treating PT
general guidelines are 30-60 mmHg for the UE, 40-80 mmHg for the LE
extremity is positioned above the heart to facilitate fluid return and to decrease strain to venous system
close monitoring of the patient for adverse reactions (numbness, tingling, increased edema above sleeve, changes in skin texture at base of sleeve
contraindicated for patients with hx of nerve disease, abdominal or genital swelling, infection, renal disease/uncontrolled HTN, and/or DVT risk.

increase in leg circumference ==> decreased compression (mmHg)
increase in bandage width ==> decreased compression (mmHg); bandage width typically increases from distal to proximal
consistently applied tension in the bandage, from distal to proximal, will result in greatest compression at the smallest diameter (e.g., greatest compression is at the most distal/dependent component of the extremity

bandages are selected which provide low resting, high working pressure (e.g., pressure increases when the limb is moving
bandages are applied in layers for optimal external pressure
bandage application approaches include figure-8 and concentric circles
multiple types of materials are used in bandaging to protect skin and increase working pressure during compression (stockinette, short stretch, foam padding)
excessive pressure should be avoided: monitor for numbness, tingling, increased swelling/indentation distal to bandage
sufficient pressure should be applied so that bandage does not shift/move considerably during active movement

Value: 1

patients are measured for a compression garment once limb girth measurements are stabilized
custom and off-the-shelf options are available
reimbursement, patient compliance (comfort, esthetics, ability to donn/doff) directly influences garment selection
lifespan of a garment is typically 3-4 months

skin care, UV protection/sunburn prevention, monitoring for infection
skin extensibility - low pH lotions
patient/family training in self-massage, exercises, compression wrapping
demonstration and practice donning/doffing garments
light exercise activity for weight management; no heavy lifting with involved extremity and avoid heat/overheating with exercise
avoiding tight jewelry or other constricting clothing
prompt health care providers so compression/trauma from blood pressure/draws on affected side is avoided.
wear gloves when working on activities where skin is at risk for tears/abrasions