There are currently three lymphoedema nurse specialists:
Pat Gardner Team leader - full time
Val Critchley 3 days a week
Ursula Dugdale 3 days a week

There are also two trained lymphoedema key workers:
Anne Lowe, District Nurse based at Adlington Clinic
Chris Burrows, Palliative Care Out of Hours Staff Nurse

Community provision

Clinic sites:
St Catherine's Hospice
Lostock Lane
Lostock Hall
PRESTON
PR5 5XU

Vine House
22 Cromwell Road
Ribbleton
PRESTON
PR2 6YB

St Catherine's Hospice Day Care
Rest/Nursing Homes
Support Groups

In-patient provision
St Catherine's Hospice
Lancashire Teaching Hospitals

Referral criteria
Consider patients for referral who have chronic swelling of:
Face/neck*
Trunk/genitals*
Limb*
Hand/foot*
Digits*

* regardless of severity

Patients are not able to self refer but any health professional involved in their care can refer a patient. Please complete a St Catherine's Hospice Specialist Palliative Care Referral Form, which are available from doctors' surgeries or you can down load. All forms must be sent to:

Sandra Hollinghurst - Medical Secretary
St Catherine's Hospice
Lostock Lane
Lostock Hall
PRESTON
PR5 5XU
Or faxed on 01772 696399

Please note
Underlying complications such as infections should be treated and any appropriate investigation should be undertaken prior to referral. Oedema can be associated with DVT or recurrence of cancer.

The urgency of the referral should be noted.

Current waiting times
Urgent - 5 working days
Soon - 2-3 weeks
Routine - 4-6 weeks

Urgent - (gross swelling)
Patients referred as urgent should have an immediate need for their symptoms of lymphoedema to be addressed either physical or psychological. Most of these patients will be palliative or terminal

Soon - (moderate swelling)
These patients will have other health problems or needs requiring an earlier appointment.

Routine - (Mild)
These patients are otherwise fit and well and their swelling could be described as mild and they have no underlying complications such as infection or the possibility of cancer recurrence or DVT.

Prior to referral of the patient, contact with the lymphoedema team is welcomed on 01772 629171.

Useful contacts
British Lymphology Society (BLS)
PO Box 196
Shoreham
Sevenoaks
TN13 9BF
Tel: 01959 5255245
Email: admin@blasac.demon.co.uk
Website: www.lymphoedema.org/bls/

The Lymphoedema Support Network (LSN)
St Luke's Crypt
Sydney Street
London
SW3 6NH
Tel: 020 7351 4480
E mail: adminlsn@lymphoedema.freeserve.co.uk
Website: www.lymphoedema.org/lsn

Clinical service
Types of chronic oedema
Lymphoedema
Lymphovenous oedema
Dependency oedema

The can be divided into two groups:
Primary
Secondary

Features of primary oedema
No identifiable cause, can occur spontaneously.
Sometimes there is a precipitating factor:
Puberty
Pregnancy/oral contraceptives
Minor trauma
Infection
Due to congenital abnormality.
Some, but not all, are inherited.

Features of secondary oedema
Identifiable cause:
Tumour
Surgery
Radiotherapy
Trauma
Infection
Immobility

Common complication of lymphoedema
Infection (cellulitis)
DVT
Recurrence of cancer

Treatment
Lymphoedema is a chronic swelling due primarily to a failure of lymph drainage. It arises from a congenitally determined abnormality or from damage to lymphatic structures by inflammation, infection, tumour, surgery or radiation. It is essentially incurable but manifestations, namely swelling and infection (cellulitis) can be improved.

(British Lymphology Society, Strategy for Care)

Mild uncomplicated oedema
Maintenance treatment is aimed at educating patients, their relative and carers about the condition and enabling them to undertake self-care.

Treatment consists of four cornerstones of care:
Skin care
Exercise programme
Compression garments
Massage

Severe or complicated oedema
Patients with severe or complicated oedema will require a course of intensive treatment, which consists of:
Manual lymphatic drainage
Multi-layer lymphoedema bandaging
Skin care regime
Exercise programme
Patients will then be expected to continue with maintenance treatment.

Treatment for palliative care
Treating patients with a palliative condition will depend on their condition, life expectancy and their wishes. Carers' wishes will be taken into account.

Individual treatments can be selected to ease particular symptoms with patient expectations matching likely outcomes.

Underlying causes and complications need to be treated.

Appointments will be arranged according to need (see waiting time criteria).

Summary
Early referral is essential.
It is not curable but can be treated
Lymphoedema, in some cases, can be prevented.

All health professionals should be able to:
identify patients at risk
recognise oedema and know routes of referral
recognise complications that arise in these patients

DNA policy
Discharge policy

* Available Request

References
BLS(British Lymphology Society) 2001 'Chronic Oedema Population and Needs' . Website: htpp://www.lymphoedema.org/bls

NHS NICE 2004 (National Institute for Clinical Excellence). 'Improving Supportive and Palliative Care for Adults with Cancer'. Topic 10.

DH (Department of Health) Feb 2004 Consultation Document. 'Standards for Better Health' Page 20. . Health Care Standards for Services under the NHS