Lymphoedema is an incurable and debilitating condition which has a negative impact on the quality of life of the sufferer and his/her family. Information with regards to diagnosis and treatment is often scarce and conflicting in nature. The following series of articles should enable nurses to recognize the condition, provide basic information to a patient and instigate treatment though referral. The first article describes the anatomy, physiology and functions of the lymphatic system. The focus is on the parts of the lymphatic system which are specific to the condition of lymphoedema and aims to place subsequent articles in context. The following articles describe the different types of lymphoedema and the four main elements of treatment that are central to the management of the condition.

The second article in this series describes the different types of lymphoedema and the signs and symptoms associated with the condition. In the preceding article (Vol 11(5): 304-9) we examined the anatomy, physiology and functions of the lympathic system in relation to the condition of lymphoedema, and demonstrated how, by acting as a one-way drainage system, the lympathics maintain tissue homeostasis through the removal of excess fluid from the interstitial spaces. Failure or dysfunction of the system can result in lymphoedema, a condition characterized by the accumulation of fluid in the soft tissues. Lymphoedema is classified into two main groups - primary and secondary. Defining the causative factors and pathogenesis of both conditions and other forms of chronic oedema will assist the reader in the clarification of the condition. The article concludes with an overview of assessment criteria for diagnosis, which should assist all healthcare professionals in appropriate referral. The third article in this series will look at the treatment of lymphoedema.

The third article in this series describes the treatment available to sufferers of lymphoedema in the UK. Lymphoedema is a condition that cannot be cured and requires lifelong treatment to control symptoms that, if left untreated, would progressively worsen. The aim of treatment is to stabilize the oedema and empower the patient with the necessary skills to undertake self-care. Four components of treatment are used to achieve this goal: care of the skin, compression and support, lymphatic massage and exercise. The purpose of each treatment will be explained and supported with research findings. Examination of the literature reveals a weak evidence base supporting treatment practice in this country. The majority of evidence relates to vascular insufficiency and findings from abroad. A brief account will be made of the reasons for this and how the trend is changing.

Supported by the NHS Lymphoedema Service Administrator, this article reports on a project undertaken by a clinical nurse specialist in Lymphoedema (CNS) and in part fulfilment of an MSc in Skin integrity skills and treatment, achieved from the University of Hertfordshire, September 2011. The need for the project was generated by the 5-day delay experienced by terminally ill patients in a hospice while waiting to receive treatment for lymphorrhoea from the community-based CNS. The training and assessment of healthcare assistants in a cost-effective treatment enabled the instigation of care within 3 hours of the development of lymphorrhoea in a patient and an evaluation of its competent delivery.

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