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Lymphedema Algorithm Evaluation Flowchart

The document outlines a flowchart for evaluating patients with limb swelling, starting with confirming laterality and chronicity while identifying red flags. It emphasizes ruling out conditions like DVT and cellulitis, gathering a focused history, conducting a targeted exam, and utilizing objective measures for diagnosis. If a diagnosis is clear, the document recommends initiating Complete Decongestive Therapy (CDT) with specific interventions based on the patient's needs.

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18 views1 page

Lymphedema Algorithm Evaluation Flowchart

The document outlines a flowchart for evaluating patients with limb swelling, starting with confirming laterality and chronicity while identifying red flags. It emphasizes ruling out conditions like DVT and cellulitis, gathering a focused history, conducting a targeted exam, and utilizing objective measures for diagnosis. If a diagnosis is clear, the document recommends initiating Complete Decongestive Therapy (CDT) with specific interventions based on the patient's needs.

Uploaded by

flapper-nays-6j
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Lymphedema Algorithm — Evaluation Flowchart

Clinic quick-reference with directional arrows

START — Patient with limb swelling


Confirm laterality and chronicity; obtain vitals; identify immediate red
flags while rooming.

Rule-Outs & Red Flags (do first)


• Acute unilateral pain/swelling → Venous duplex to r/o DVT
• Fever/erythema/warmth → Treat cellulitis; defer MLD/compression over hot
area
• CHF/renal/hepatic decompensation → Stabilize before CDT

Focused History
Onset/trajectory; surgical/RT/trauma/infection risks; symptoms (heaviness,
tightness, diurnal change); cellulitis history; prior CDT/MLD/compression;
impact on ADLs/QOL.

Targeted Exam & ISL Stage


Distribution (dorsum hand/foot, digits), Stemmer sign, pitting vs fibrosis,
skin changes; venous signs. Stage 0–III. Capture photos.

Objective Measures
Circumferences/volume → %/cm asymmetry; BIS/L-Dex if available (∆ from
baseline). Record PRO (LLIS/LYMQOL) and pain score.

c suspected NO/UNCERTAIN →
udy; labs/echo Lymphoscintigraphy (con
Diagnosis clear from H&P + measures?
tributors. physiology); ICG lymphog
(pattern/mapping); MR
lymphangiography (anato

YES → Initiate CDT


Start Phase I CDT: MLD, short-
stretch bandaging, skin care,
This tool supports, not replaces, clinical judgment.exercise; fit compression
© Lymphedema Expert (UE 20–30;
LE 30–40 as tolerated).

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