Guidelines for managing people with lymphoedema remotely: a post-COVID-19 response document
During the COVID-19 pandemic it was initially not possible to see people with lymphoedema face-to-face at lymphoedema services, due to the potential risks of the virus, because they were shielding, because of redeployment of rooms or staff, and due to sporadic restrictions of movement. The pandemic therefore accelerated adjustments in lymphoedema service delivery, while ensuring effective and efficient care was paramount. This document presents a pragmatic guide for lymphoedema services. Although clinical and non-clinical staff need to comply with guidance from their own organisations/commissioners, this document aims to provide specific guidance and share good practice in relation to lymphoedema management. These guidelines are based on analysis of the national response of Lymphoedema Network Wales during the first few months of the COVID-19 pandemic and incorporate supporting contemporary advice. They have been used throughout NHS Wales, providing a standardised approach in supporting care for people with lymphoedema. In light of the enduring nature of COVID-19, it is imperative that lymphoedema services have a means to provide suitable care for patients. Although face-to-face appointments are sometimes deemed necessary, many patients can be suitably supported via telehealth consultations. These guidelines may help lymphoedema services restore and reset in a safe and acceptable manner.
People with lymphoedema need appropriate and timely advice, support, and sometimes hands-on expert treatment in order to manage their condition. Without appropriate intervention, this progressive chronic condition can cause increasing distress, disability and deformity through swelling of limbs, trunk or face, and through damaging changes to the skin become at risk of cellulitis infections (Fu et al, 2013). Although lymphoedema can make a person more vulnerable to skin infections, it is not thought to increase the risk of contracting COVID-19 nor of increasing the severity of symptoms, except in a rare version of lymphoedema that affects the lungs (Lymphoedema Support Network and Lymphatic Education and Research Network, 2020). The reality, however, is that a significant proportion of patients on a standard, mixed lymphoedema caseload have co-morbidities that may make them vulnerable (Al-Niami and Cox, 2009; Son et al, 2019). The issues of shielding, reducing personable contacts and isolation therefore become particularly relevant to this population.
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