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Wirral University Hospital NHS Foundation Trust

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Lymphoedema Service

The Lymphoedema Service provides treatment for patients with predominantly non-cancer related lymphoedema.  If patients have lymphoedema as a direct result of cancer, they will be referred to the Clatterbridge Cancer Centre Lymphoedema Service.

The Lymphoedema Service is provided for patients who wish to be referred, and who have swelling which has been present for more than 3 months.  Initially patients are referred via their GPs to the Vascular Consultants at Wirral University Teaching Hospital (WUTH). 

There are 3 clinical nurse specialists, a clinical support worker and an administrative clerk present in the Lymphoedema team.  The service is open daily from 8.30am until 5pm excluding weekends and Bank holidays.    

What is lymphoedema?

Lymphoedema is a long term (chronic) condition that manifests itself as swelling which has been present for more than 3 months.  It can affect any body part, but is mostly seen in arms and legs.  It can be due to:

  • Primary lymphoedema which is a failure in the lymphatic system which often is present at birth, or may appear later in life.

Or

  • Secondary lymphoedema, which occurs when there has been damage to the lymphatic system, due to trauma, infection, post Deep Vein Thrombosis, or cancer and cancer treatments.  Immobility, cardiac failure, or venous insufficiency can also cause oedema, as can certain medications. Obesity appears to increase the risk of lymphoedema.  In this case, as there is often no abnormality to the lymphatics, weight loss and healthy eating is likely to lead to a reduction in swelling.  Bariatric surgery may also be recommended. 

What are the symptoms of Lymphoedema?

The main symptom of lymphoedema is swelling in all or part of a limb or another part of the body. It can be difficult to fit into clothes, and jewellery and watches can feel tight.

At first, the swelling may come and go. It may get worse during the day and go down overnight. Without treatment, it will usually become more severe and persistent.

Other symptoms in an affected body part can include:

  • an aching, heavy feeling
  • difficulty with movement
  • repeated skin infections
  • hard, tight skin
  • folds developing in the skin
  • wart-like growths developing on the skin
  • fluid leaking through the skin

What is Lipoedema?

Lipoedema is another condition that is often confused with lymphoedema or obesity.  It involves bilateral and symmetrical swelling of the legs, and can also affect the thighs, hips, buttocks and arms.  It is due to the abnormal accumulation of fat cells in the tissues in the skin. 

This can lead to lipolymphoedema (where it progresses to oedema/swelling due to fluid overload) if not managed.  Lipoedema can cause pain or tenderness in the affected limbs. 

Cellulitis

Patients with lymphoedema are particularly susceptible to cellulitis, as the lymphatic system does not function adequately. 

Cellulitis is a bacterial infection of the skin which may cause redness, heat, swelling, temperature and pain.  It can also cause lymphoedema if it damages the delicate lymphatic system.

Assessment

When you are reviewed in the Lymphodema clinic, the clinical nurse specialists will assess your condition and will provide a diagnosis and treatment plan.

The assessment will involve taking your past medical history and current medications, so it would be useful to bring your medications with you. 

Your limbs will be examined and measured, so it is best to wear loose clothing.  Some patients require further investigations.  You should expect to be in the department for 90 minutes.  If you need to attend by ambulance, you should let the administrative clerk know, who will book you in for a morning appointment.

Treatment of lymphoedema

Unfortunately, there is no known cure for lymphoedema, and treatment varies depending on the severity.  

Treatment plans will be individually devised and may consist of: skin care, exercise, Simple lymphatic drainage/manual lymphatic drainage, a specialist technique to help with lymph drainage, and compression garments, which are often needed life-long. 

Bandages, wraps, Kinesio tape and pneumatic compression (IPC), are also treatment options.  If a course of bandaging is required, you will attend as an out-patient 2 to 3 times a week for bandage renewal. This will be over a period of 2 to 4 weeks and you will also go to bed with the bandages on of a night.  Sometimes night time compression is also recommended permanently. 

We may also recommend that you have treatment with other specialities, such as community nurses, practice nurses, Tissue Viability. 

As Lymphoedema is a long term condition that can be progressive, life-long self-management is important, so you will be taught how to manage this condition independently, which requires a high level of motivation and compliance.

Patients will usually be discharged once they have been stable for 12 months.  Patients who are non-compliant with their plan of care or do not accept treatment will, as well as non-attendance at appointments will also be discharged. 

 

Contact details

Mr Chandraseker, Lead Vascular Consultant for Lymphoedema Team
Secretary: Sue Wilson 0151 678 511 Ext 2219

Lymphoedema Lead Specialist Nurse: Senior Sister Jenny Williamson

Lymphoedema Specialist Nurses: Sisters Jane Roles/Heather Pidcock (Known as Lol)

Internal Extension: 5122
Direct dial: 0151 482 7688 or Ext. 5122

An answer phone is available if you are unable to speak with a member of staff.  All messages will be dealt with either during the working day or the following day.