Wound care with lymphedema in Arnold.

What to know about wounds with lymphedema

Wounds form on a limb with lymphedema because swollen tissue is fragile tissue. Fluid pushes skin cells farther from the small blood vessels that feed them, so oxygen and nutrients arrive slowly. The stretched surface tears easily, and a scratch from a pet, a bump against a bed frame or a rubbing shoe can open it.

Once the skin is open, lymph fluid seeps out. The steady moisture softens the surrounding skin until it turns white and breaks down, and the open area widens. Bacteria that would normally be carried away by lymph flow linger in the tissue. Each problem feeds the next, which is why treating clinicians usually address the swelling and the wound in the same plan.

What the treating clinician looks at

Compression is the main tool for reducing lymphedema, but it is not right for every limb on every day. Before ordering it, the treating clinician checks blood flow to the foot or hand, sometimes with a simple circulation test, because squeezing a limb with poor arterial supply can do harm. Heart and kidney conditions are reviewed, since moving fluid out of the legs places extra load on the heart. Loss of feeling in the feet also matters. A person who cannot feel a wrap digging in cannot report it.

With that information the clinician decides whether to use compression, what kind, and how firm. The decision is revisited as the limb changes.

Arranging this care in Arnold

In many households in Arnold, the family member who helps with wraps leaves early for work and gets home late. That leaves a long stretch when a wrap that slips or a dressing that soaks through has no one to fix it. Tell the treating clinician about the household schedule. Orders can sometimes be built around it, and home health nursing during the day may be an option. If your relative lives in one of the newer senior living communities, Gateway coordinates with the staff there as well.

Housing in Arnold ranges from older ranch homes near the center of town to newer subdivisions, townhomes, apartment complexes and manufactured home communities. Hilly lots and sloped driveways are part of the landscape. The area also has senior apartments, assisted living and skilled nursing and rehabilitation centers. Gateway arranges partner clinician visits in all of these. For a home visit we ask about entry steps and where the patient rests. For a facility resident we coordinate with the director of nursing or the unit staff so orders reach the people carrying them out.

Care at home

Most of the work on a lymphedema wound happens between visits. The treating clinician leaves instructions for the days in between, and they usually cover washing and thoroughly drying the skin, using a moisturizer if one is ordered, keeping wraps or garments on as directed and resting with the limb raised.

Wraps slip, dressings soak through and questions come up. Ask at the visit whom to call when that happens and what to do in the meantime, so no one is left guessing on a weekend. If part of the routine is not working, say so. A plan can be adjusted, but only if the clinician hears about the problem.

Care in skilled nursing and assisted living

A resident with lymphedema usually has other conditions that the attending physician is managing, and several of them influence swelling. The treating wound clinician and the attending physician need the same information: what the wound looks like, what compression is in place, and whether fluid, weight or medicines have changed.

Gateway handles the paperwork side of that exchange. Visit findings and recommended orders go to the attending physician and the director of nursing, and relevant labs or notes from the facility come back to the wound clinician. Each clinician keeps authority over their own decisions, and the facility keeps one clear record.

Changes to report

Compression should feel snug and supportive. It should not hurt. Report these problems to the treating clinician, and ask ahead of time what to do if one of them shows up at night or on a weekend:

• Numbness, tingling or a pins-and-needles feeling below the wrap
• Toes or fingers that look pale, blue or dusky, or feel cold
• Pain that builds under the wrap instead of easing
• A wrap that has slid down, bunched up or formed a tight band
• Fluid soaking through the outer layer

Call 911 for chest pain, sudden shortness of breath, or a foot or hand that turns cold, white and severely painful.

Primary care and overall health

Medicines are part of the swelling picture. Some commonly prescribed drugs, including certain blood pressure, diabetes, pain and hormone medicines, can cause the legs to hold fluid. Water pills reduce some kinds of swelling and do little for others, and they can affect the kidneys and blood pressure along the way.

Sorting this out is a job for the prescriber. Do not stop or change a medicine on your own because of swelling. A primary care visit that includes a full medication review gives the prescriber and the wound clinician a shared, current list, and Gateway coordinates the records so both are working from it.

Primary care at home in Arnold →

Getting care arranged in Arnold

For a resident of a nursing home, assisted living or memory care community in Arnold, a request for wound care with lymphedema can come from the family, the resident or the facility’s nurses. Call 314-325-0126 and give us the facility name, the unit or room and the best nurse contact. Gateway speaks with the facility about its process for outside clinicians, confirms availability and coordinates a visit time that fits the resident’s day. After the visit, the treating clinician’s orders are given to facility nursing, and the family contact on file gets an update if the resident has agreed to that.

Arnold residents commonly use three hospitals: Mercy Hospital South just north of the Meramec, Mercy Hospital Jefferson in Festus down Interstate 55, and SSM Health St. Clare Hospital in Fenton, reached by Route 141. Gateway has no affiliation with them. If you are a family member, tell us which hospital and the expected discharge date, and we will request records. If you are a discharge planner, fax the referral with the face sheet and wound orders. We then check availability in 63010 and arrange the first follow-up visit with a treating clinician.

• County: Jefferson County, Missouri
• ZIP codes: 63010
• Nearby hospitals: Mercy Hospital South; Mercy Hospital Jefferson in Festus; SSM Health St. Clare Hospital in Fenton (not affiliated with Gateway)
• Nearby communities: Jefferson County, Oakville, Imperial, Fenton, Mehlville
• Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in Arnold

Read the full guide to wounds with lymphedema, or see everything Gateway arranges on the mobile wound care in Arnold page.

• Diabetic foot ulcers
• Venous leg ulcers
• Pressure injuries and bed sores
• Arterial and mixed wounds
• Non-healing wounds
• Post-surgical wounds
• Reopened (dehisced) surgical wounds
• Surgical site infections
• Skin tears and traumatic wounds
• Skin graft aftercare
• Wound VAC (NPWT) follow-up
• Wound care with lymphedema in Jefferson County
• Wound care with lymphedema in Oakville
• Wound care with lymphedema in Mehlville

Common questions