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Worcestershire Health and Care NHS Trust
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INDICATIONS FOR REFERRAL TO THE LYMPHOEDEMA SERVICE

Primary Lymphoedema – due to congenital abnormalities of the lymph conducting system

Secondary or Acquired Lymphoedema– caused by damage to the lymphatic vessel and/or lymph nodes, or from functional deficiency.  It may also be the result of high output failure of the lymphatic circulation, when the function of the overloaded system eventually deteriorates.

This is due to:

  • Cancer/cancer related treatments/end of life oedema
  • Trauma/tissue damage
  • Genetic predisposition/Family history
  • Recurrent infection/chronic inflammatory changes
  • Lymphadenopathy
  • Venous disease
  • Lipoedema – a bilateral and usually symmetrical limb swelling. It is thought to occur as a result of an abnormal accumulation of fat cells within the tissues under the skin
 

Contact Us:

whcnhs.lymphoedemaworcestershire@nhs.net 

or Worcestershire Lymphoedema Service, 2nd Floor Pershore Hospital, Queen Elizabeth Drive, Station Road,
Pershore, WR10 1PS. 

Contact number: 01386 502030

Click here to download Worcestershire Lymphodema Service referral form 

AIMS OF THE SERVICE

The aim of the service is to deliver specialist education, support, information and treatment of primary and secondary related lymphoedema using a multi-disciplinary approach.

To improve the overall quality of life for patients with lymphoedema/lipoedema by devising individualised holistic care plans and wherever possible promoting self-management and well-being.

SERVICE PROVISION

A specialist service for the treatment of Primary/Secondary Lymphoedema and Lipoedema.

To act as an information resource for all members of the wider multi-disciplinary team and health professionals.

To advise, educate and support GP practices, practitioners and allied healthcare professionals in caring for patients with lymphoedema/lipoedema.

To empower patients/carers and families to be actively involved in individualised treatment plans through teaching and support ultimately promoting self- awareness and self-management.

To reduce hospital admissions by engaging patients/carers and health care professionals in awareness of cellulitis and its effect both acutely and chronically on lymphoedema/lipoedema.

The service is a countywide out-patients service, based at the lymphoedema clinic at Pershore Hospital, but also offering satellite clinics at Kemp Hospice (Kidderminster), Primrose Hospice (Bromsgrove) and St Richards Hospice (Worcester).

PATIENT REFERRAL CRITERIA

Referrals will be accepted by the lymphoedema service subject to the following conditions:

The patient is registered with a Worcestershire GP

The patient has a definite diagnosis of Primary/Secondary lymphoedema and any complex lymphoedema/oedemas that despite treatment already in situ cannot be managed effectively within the community setting, or that require further specialist knowledge.

The patient must be aware of the referral. Long term success will depend on patients and/or their carers or families being able to understand, engage in and continue with the agreed treatment plans.

Patients should be actively encouraged to reduce their BMI to less than 25. Patients with a BMI above 30 should be offered dietary advice/input and need to show a consistent weight loss over a 3-6 month period prior to the referral to the service being generated. The reasoning for this is to try and reduce a potential cause factor for the swelling in the first instance, which would result in improving the swelling and its symptoms.

From Monday 25th February 2019, Worcestershire Health and Care NHS Trust Lymphoedema Service will accept online referrals only. 
This will replace the previous method for referrals. 
Click here to access the Worcestershire Lymphodema Service Referral Formwhich should be completed and emailed to whcnhs.lymphodemaworcestershire@nhs.net
Referrals are only accepted via the Lymphoedema referral form. Appointments will not be allocated until this is completed. General telephone and /or email advice is available for health care professionals. Referrals are reviewed and processed on a weekly basis. The appointments are prioritised as below:

Urgent

Patients with a palliative/terminal diagnosis will be contacted within 5 working days of the referral being received

Routine

All other referrals will be reviewed and allocated appointments at an available clinic 

Please Note

The lymphoedema team are only able to offer home visits to patients with a palliative/terminal diagnosis. We are unable to see any other patients at home.

CONTRAINDICATIONS /EXCLUSIONS FOR LYMPHOEDEMA TREATMENT

Patients with oedema due to unstable cardiac or renal failure.

Patients with an ankle brachial pressure index (ABPI) of less than 0.5 as lymphoedema compression therapy is contra-indicated. Patients with an ABPI of 0.5 – 0.8 should be considered for reduced compression therapy and be closely monitored. If there is any doubt about the patients arterial status a vascular opinion should be sought. (Best Practice for the Management of Lymphoedema 2006)

DISCHARGE PROCEDURE

Patients with less than 10% swelling will be reviewed within 12 months and if the limb volume remains within this parameter they will be discharged.

Patients who have stable, non- complex oedemas who are wearing compression garments will be discharged back to their GP after 12 months if limb stability is achieved. This applies to both upper and lower limb swelling.

Patients who choose not to follow the advice and treatment plan agreed after every effort has been made by the specialist team to actively engage them in their own stages of treatment will be discharged regardless of the severity of the condition.

Patients who do not attend their appointment and fail to make further contact with the service will be discharged regardless of the severity of their condition.

It is the responsibility of the patients/carers to make contact with our specialist service for their next appointment. Any patient who has not been in contact with the service for over 12 months will be discharged automatically, regardless of the severity of the condition.

Ref: Lymphoedema Framework: Best Practice for the Management of Lymphoedema. International Consensus. London. MEP Ltd, 2006.

The Lymphoedema Support Network, St Lukes Crypt, Sydney Street, London