There is a wide array of compression garments to choose from and deciding which one is suitable can be daunting. Having the right fit is the most important aspect - compression garments are effective only if they are worn consistently and the patient is satisfied. Therapeutic benefit is lost if the garment is stored away. Please consult with your lymphedema therapist, doctor and fitter to find the best one for your unique needs.
The “grades” for compression are measured in mmHg (millimeters of mercury just like the pressure of a blood pressure cuff):
· 15-20mm Hg – no prescription required; preventative; for tired achy legs; good for mild swelling experienced on airplane flights
· 20-30 mmHg (class I) – prescription required; for mild lymphedema in upper or lower extremity
· 30-40 mmHg (class II) – prescription required; for moderate lymphedema in upper or lower extremity
· 40-50 mmHg (class III) – prescription required; for severe lymphedema especially of lower extremity
· 50-60 mmHg (class IV) – prescription required; for severe lymphedema of lower extremity
Flat Knit vs. Circular Knit Material
Most ready made garments are circular knit and flat knit are generally custom made. Higher levels of pressure (>50mmHg) can only be achieved with flat knit garments. Circular knit fabrics are less expensive and cosmetically more attractive because they do not have a seam and can be produced using finer and sheerer materials. Flat knit garments are more dense but provide a more precise fit, but because of their construction when stretched over a limb there are more holes for the skin to breathe.
Custom measure vs. Off-the Shelf/pre-made
Custom fitted garments are made for limbs that have an unusual shape such as the top of the limb is much larger than the bottom, or the limb does not fit into the manufacturer sizing charts. Since the greatest compression needs to be at the distal end (lower arm or leg) of the limb if the garment fits the top of the limb and is loose at the bottom this may cause the fluid to travel down to the hand or foot. If the limb is symmetrically larger all over, the person may be able to fit into a ready made “off the shelf” garment. At no time should the
garment have a tourniquet effect which will cause more swelling below the level of the tight area.
COBAN 2 LAYER SYSTEM: CHANGING PRACTICE, CHANGING LIVES
Many inconsistencies exist in lymphedema management across Canada. Some provinces cover costs related to either compression garments or treatment, while others provide no coverage and therefore patients seek out a lymphedema therapist in private practice. Complete Decongestive Therapy includes many components of care such as manual lymph drainage (MLD), compression (bandaging/garments), meticulous skin care, exercise and instructions in self care. Although MLD is indicated as a component, current research does not support edema reduction with MLD alone however there is strong evidence that compression bandaging alone reduces edema.
Consequently, many patients are not receiving appropriate treatment for their lymphedema and untreated or unmanaged ultimately costs the health care system more due to side effects that require repeated intervention.
Moffatt, in 2003, found that for every pound (GBP) spent on lymphedema treatments in the UK, one hundred pounds was saved in reduced hospital admissions.
My experience, as a clinical lymphedema therapist using the Coban 2 compression bandage was that it provided me the ability to treat more patients and achieve effective volume reduction as well.
It allowed for greater comfort, function and mobility and less slippage due to the cohesive abilities. It also allowed patients to wear their own footwear, exercise more easily and continue with their activities of daily living.
Coban 2 applied twice weekly is a simplified application technique that is convenient and comfortable for patients. Also, relevant, is the significant lower cost of care resulting from fewer patient visits required to achieve edema reduction. Patients can continue to work or return to work with few restrictions requiring less time off due to less frequent visits.
Therapists please contact Susanne Ruhl at firstname.lastname@example.org for local training opportunities.