Oedema is a common feature in many long term-conditions including:
- Advanced cancer
- Chronic Heart Failure
- Advance neurological and liver disease
- End stage renal disease
- End stage chronic respiratory disease
Causes of oedema can be multi-factorial in this patient group. Assessment is important to identify all these factors to ensure the patient is treated appropriately. However, treatment outcomes are often restricted by the progressive nature of the underlying illness, concurrent symptoms and poor prognosis. With this in mind it is important to adopt a realistic needs based approach to ensure treatment plans are comfortable and effective for the patient and those who matter.
The aim in end of life patients with oedema is to provide comfort and to minimise further increase if possible rather than trying to reduce the oedema. This may include:
- Skin care – In this patient group the skin can be fragile,dry and vulnerable to trauma as a result of the oedema, disease process and medications. It is important to ensure the skin is kept clean, moisturised and free from possible trauma to eliminate the risk of possible infection (link to skin care).
- Support and positioning – Ensure adequate support and positioning of the swollen limb(s) by using pillows, foot stool, recliner chair to aid comfort and avoid prolonged dependency.
- Compression – Several factors may limit the use of compression in this patient group e.g. pain, speed of deterioration, presence of fungating lesions, cellulitis in the affected limb.
Option for consideration include the use of light tubular bandage e.g. comfifast or tubifast, light bandaging or low compression garments.