“Protect the Limb” Protocol

The Operating Room can be a source of occult trauma for extremities whether they be “lymphedema-affected”, “at-risk” or “pending at-risk”. Sensitive individuals commonly note the possible risk of an inadvertent wrong-side venupuncture or blood pressure measurement. Other environmental risk factors must include pressure point trauma associated with prolonged immobility under anesthesia and unintentional trauma to the extremity during patient position changes.

The “Protect the Limb” Protocol was developed at our associated Centers of Excellence in Lymphedema Care to address this challenge. Patients at our centers undergo a pre-operative evaluation by a Certified Lymphedema Therapist (CLT) to include inspection of the skin and limb measurements. Dedicated pre-operative nurses interview each patient and identify involvement and risk of all 4 extremities prior to any testing or therapy. Venous access options are identified and prioritized along with our dedicated Anesthesia Staff prior to blood draws, IV catheter placements and blood pressure measurements. On the day of surgery, all “lymphedema-affected”, “at-risk” or “pending at-risk” limbs undergo Vodder Method Manual Lymphatic Drainage and placement of a foam-based 3/4 length compression bandage in the pre-operative holding area prior to be moved into the operating room. Foam-based compression bandages protect limbs from excess extremity swelling secondary to fluid shifts during and after surgery. Further, foam-based compression bandages provide a “protective skin” for underlying soft tissues, nerves and boney prominences during immobility. Continuous pulse oximetry is performed on the protected limb during and following surgery to insure adequate perfusion of the limb. This safety measure alerts our surgeons and anesthesiologists to any interruption of blood flow to the extremity with patient position changes.

We believe attention to details as these provide each and every patient the highest level of limb protection against even the smallest trauma that may contribute to the development of extremity lymphedema. Being proactive is a key component of our unique and personalized care treatment plan available at our associated Centers of Excellence in Lymphedema Care.

Surgeons and care providers at our associated Centers of Excellence in Lymphedema Care never forget to “protect the limb!”