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Please visit the UHN Patient Education website for more health information: www.uhnpatienteducation.ca© 2015 University Health Network. All rights reserved. This information is to be used for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis or treatment. Please consult your health care provider for advice about a specific medical condition. A single copy of these materials may be reprinted for non-commercial personal use only.
Author: Stephanie Phan, Sylvia Crowhurst, Pam HammondCreated: 02/2015Form: D-8519
For patients with lower body lymphedema who have had treatment for gynecologic cancer, including:• Removaloflymphnodesinthepelvis,• Removaloflymphnodesinthegroin,or• Radiationtothepelvis
Read this resource to learn:• Whoneedsself-bandaging• Whyself-bandagingisimportant• Howtodoself-bandaging
Disclaimer:Thispamphletisforpatientswithlymphedema.Itisaguidetohelppatientsmanagelegswellingwithbandages.ItisonlytobeusedafterthepatienthasbeentaughtbandagingbyaclinicianattheLymphedemaClinicatthePrincessMargaretCancerCentre.
Howtoself-bandageyourleg(s)andfeettoreducelymphedema(swelling)
PrincessMargaret
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Do not self-bandage if you have an infection in your abdomen, leg(s) or feet.
Signsofaninfectionmayinclude:• Swellingintheseareasandrednessoftheskin(thisrednesscanquicklyspread)
• Paininyourleg(s)orfeet• Tendernessand/orwarmthinyourleg(s)orfeet• Fever,chillsorfeelingunwell
If you have an infection or think you have an infection, go to:• YourFamilyDoctor• Walk-inClinic• UrgentCareClinic
Ifnowalk-inclinicisopen,gototheclosesthospitalEmergencyDepartment.
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What is the lymphatic system? Yourlymphaticsystemremovesextrafluidandwastefromyourbody.Itplaysanimportantroleinhowyourimmunesystemworks.Yourlymphaticsystemismadeupoflymphnodesthatarelinkedbylymphvessels.
Yourlymphnodesarebean-shapedorgansthatarefoundalloveryourbody.Largegroupsorchainsoflymphnodescanbefoundinyourneck,underyourarmsandinyourgroin(seepicturetotheright).
Havingsurgerytoremovelymphnodes,orradiationtreatmenttoareasinyourbodywhereyouhavelymphnodes,canpreventfluidfromflowingproperly.Thiscancauseswellingcalledlymphedema.
The Lymphatic SystemCirclesshowwhereclusters(groups)oflymphnodesareinyourbody.Itisnormalforlymphnodestoberemovedduringcancertreatment.
How does self-bandaging help with lymphedema?Ifyouhadsurgeryand/orradiationtreatmentforgynecologiccancer,theareasthatmayhaveswellingincludeyourfeetandleg(s).Wrappingyourbodywithbandages(compression),helpsmovethelymphfluidinthedirectionoftheheart.
Thegoalofbandagingisto:• Helpreduce yourswelling• Helppreventtheswellingfromgettingworse
Theshortstretchbandagesthatyoushouldusearedesignedforpatientswithlymphedema.AsktheLymphedemaClinicstaffforalistofplaceswhereyoucanbuythesebandages.
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When should you wear the bandages?• Tobemostuseful,bandagesshouldbewornduringthedayandwhenyouexercise.
• Itiscommonforthebandagestoslipdownwithmovement.Thebandagescanalsoslipifyourlegbecomeslessswollenasyouwearthem.Youmayneedtowrapthebandagesagainifthishappens.
• Youmayalsobandageatnight,onceyouarecomfortablewearingthem.
What should you do before you start? • Cleanyourskinwithsoapandwaterandpatitdry.Makesuretodrybetweenyourtoes.
• Checkyourskinforanybreaks(cuts)orredness.Ifneeded:
• Cleanthecutandapplyabandage.Donotwrapwithcompressionbandagesuntiltheskinhashealed
• Ifthereisredness,followtheinstructionsabove.Itmaybeaninfection.Donotwrapwithcompressionbandagesuntiltheinfectionhasgone.
• Applymoisturizer(lotion)toyourskin.Thiswillhelpyoutoavoiditchiness,irritationandskinbreakdown.
• applyaskinlotiontoyourlegandfoot
• rubitintoyourskin
• pullonthetubularcottonsock(stockinette).Itwillpreventthelotiononyourskinfrombeingrubbedoffbythebandage.
• Makesureyouareinacomfortablepositionwhilebandagingtoavoidanybackdiscomfort.
Please follow instructions given by the clinic staff at the Lymphedema Clinic.
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Have all your supplies ready before you begin
Bandagingsuppliesmayinclude:
1.Stockinette(tubularcotton)toprotectthelegandfoot
2.Padding(softwhiteartiflex/castorpaddingorfoam)tohelpwithpressureofthebandages
3.Gauze(white,4cmand/or6xcm)bandageforyourtoes
4.Short stretch bandagesforyourfeetandlegs(beige,8cm,10cmand/or12cm)
5.Kidney-shapedhard foamforswellingbehindyourankles
Bandagingsuppliesmaydifferbasedonyourspecificneeds.Youwillonlybegiventhesuppliesyouneed.Askadoctor,nurseortherapistattheLymphedemaClinicforthepamphletcalled“HowtoCareforYourBandages”.
Foot and ankle padding
Toe gauze
Short stretchbandagesTape
Stockinette
Leg padding
Foam for ankles
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Step 1. Bandaging the toes
• Putthestockinette(tubularcotton)onyourleg• Pullitbacktobandageyourtoes.
• Beginwiththe4cmtoegauzeandwrapitoncearoundthebaseofallyourtoes.Wrapthebigtoefirst.
• Startfromthebottomofthetoenailandwraparoundthetoetwotothreetimestowardsthebaseofthetoe.
• Do not stretch gauze as you bandage the toes.
• Wrapthegauzearoundthebaseofallthetoesagain.
• Wrapthe2ndtoe(theonenexttoyourbigtoe)thesamewayasthebigtoe.
• Continuewrappingeachtoethesameway.• The4thand5thtoecanbewrappedtogetheroryoucanleavethe5thtoeunwrapped.
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Option: ToeWrapwithAdhesive(sticky,glue-based)GauzeYoucanuseadhesive(stickyorglue-based)gauzetobandageyourtoesseparately.• Wraparoundeachtoewithoutpullingthegauze.• Youcanleavethe5thtoeunwrappedifyouchoose.
Whenyoufinishbandagingyourtoes,checkyourbloodflowbydoingthefollowingtest:• Pressonthebigtoenail.Itshouldlosesomecolourorturnpale.
• Thecolourwillreturnafterafewsecondswhenyoureleasethetoe.
• Ifthisdoesnothappenyoumayhavebandagedtootightly.Youwillneedtoremovethebandageandwrapitmoreloosely.
The toe bandages should feel comfortable. You should have no pain or discomfort.
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Step 2. Foam for ankles
Iftheskinaroundyouranklebonesisthickandspongy,youmayhavebeengiventwopiecesofthickfoam(kidney-shaped)tohelpwiththeswelling.
• Placethefoambehindtheanklebones.
• Wrapthe6cmlargergauzearoundthefoamsothatitdoesnotslip.
• Pullthestockinettebackovertheankleandfoot.
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Step 3. Applying padding to the foot and leg
• Withthe10cmpadding:Wraparoundyourfootbeginningatthebaseofthetoes.
• Wraparoundthefootagainmovingclosertotheankle.Coverthewholefoot.
• Overlapthepaddingbyhalfwitheachwrap.
• Continuewiththispaddinguptheleginthesameway.
• Makesurethebackofthekneeiswellpaddedandprotected.Youmayhavebeengivenanextrapieceofpaddingforthisarea.
• Continuethepaddingtojustunderthegroin(abouttwofingerwidthsbelowgroin).
• Trytosmoothoutthewrinklesinthepaddingasbestasyoucan.Donotusetapeasitmaytearthepadding
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Step 4. Bandaging the foot and ankleBandage #1
• Trytokeepyourfootata90-degreeanglewhenyouwrapthefoot.
• Beginwiththe8cmbandage(beige).Wraparoundthefootatthebaseofthetoes without pulling.Thiswillsecurethebandage.
• Nowwraptwotothreemoretimes,pullingthebandageacrossthetopandacrossthebottomofthefoot.
• Giveagentlepullonthebandageateachhalfturntokeepevenpressure.
• Continuewiththesamebandageacrossthetopofthefoottowardthe back of the ankle.
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• Wrapthebandagearoundthebackoftheankleandacrossthetopofthefoot.
• Alwaysgiveagentlepullonthebandageateachhalfturntokeepevenpressure.
• Bringthebandagearoundtothebottomofthefoot.Thenacrossthetopofthefootagain,movingthebandageclosertotheheel.Thispatternofwrappingiscalleda“figure8”.
• Alwaysgiveagentlepullonthebandageateachhalfturntokeepevenpressure.
• Repeatthisfigure8patternaroundthefootandankleuntilthearchofthefootiscovered.
• Continuewiththeremainingbandagearoundyourankleandupyourlowerleg.
• Overlapthebandagebyhalfwitheachwrap.• Alwaysgiveagentlepullonthebandageateachhalfturntokeepevenpressure.
• Tapetheendofthebandagetopreventitfromloosening.
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Step 5. Bandaging the legBandage #2
• Takea10cmbandage:Wraparoundjustabovetheanklewithout pulling.Thiswillsecurethebandage.
• Wrapagainandgentlypullacrossthefrontandthenthebackoftheleg.
• Overlapthebandagebyhalfwitheachwrap.• Alwaysgiveagentlepullonthebandageateachhalfturntokeepevenpressure.
• Continuewiththesamebandage.Bendthekneeslightlyifpossible.
• Wrapthebandageover the knee.Thenwrapbelow the kneeandfinallyabove the kneeinafigure8pattern.
• Continuewrappingtheupperlegandtapetheendofthebandagetopreventitfromloosening.
• Alwaysgiveagentlepullonthebandageateachhalfturntokeepevenpressure.
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Bandage #3
• Takeanother10cmbandage.Feelyourankleandlowerlegandstartthebandagewhereitfeelssoft.
• Wrap in the opposite direction to the previous bandage.
• Wraparoundthelowerlegwithout pulling.Thiswillsecurethebandage.
• Wrapagainandgentlypullacrossthefrontandthenthebackoftheleg.Overlapthebandagebyhalfwitheachwrap.
• Dothefigure8wrapovertheknee(asdescribedbefore).Thiswillhelpwithkneemovement.
• Alwaysgiveagentlepullonthebandageateachhalfturntokeepevenpressure.
• Placeyourweightonthelegthatyouarebandaging,ifpossible.
• Continuewrappingtothetopofthelegandtapetheendofthebandagetopreventitfromloosening.
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Option: AddedBandage• Youmayhavebeentoldtoaddanotherbandage.• Ifso,wraptheaddedbandageinthesamewaystartingbelowtheknee.• Continuebandagingtowardtheupperlegandtapetheendofthebandagetopreventitfromloosening.
Whenyoufinishbandagingyourleg,checkyourbloodflowbydoingthefollowingtest:• Pressonyourbigtoenail.Itshouldlosesomecolourorturnpale.
• Thecolourwillreturnafterafewsecondswhenyoureleasethetoe.
Ifthisdoesnothappenyoumayhavebandagedtootightly.Youwillneedtoremovethebandageandwrapitmoreloosely.
The leg wrap should feel comfortable. You should have no pain or discomfort.
What should you avoid?• Donotstrainyourshoulders,neck,armorhand.• Donotwrapthebandageinawaythatcausesyoupain.• Donotcontinueself-bandagingifitiscausingyoupain.Ifpaincontinues,follow-upwithyourdoctororheathcareteam.
• Donotdoself-bandagingifyouhaveaninfectioninthatarea.
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Contact informationIfyouhavequestionsaboutself-bandaging,pleasecontacttheSurvivorshipClinicat416-946-4501,extension2363,andasktospeakwithoneoftheclinicstaffmembers.
Notes/Comments
ThedevelopmentofpatienteducationresourcesissupportedbythePrincessMargaretCancerFoundation.