Lympho-venous Insufficiency: Management Strategies and Clinical Role

This report provides a comprehensive overview of lympho-venous insufficiency, a medical condition characterized by extracellular fluid accumulation due to damage to the lymphatic system. It delves into the etiology, distinguishing between primary and secondary lymphedema, and explores the pathophysiology, highlighting the lymphatic system's role in fluid filtration and transport. The report examines prevalence, particularly among cancer survivors in Australia, and discusses prognosis and management strategies, including both non-surgical (conservative) and surgical interventions. Non-surgical approaches like complex decongestive therapy (CDT) and the use of compression garments are emphasized. The dermal clinician's role in skin care recommendations, including emollient therapy, is thoroughly discussed, and the importance of interprofessional management, involving lymphologists, nurses, nutritionists, and physical trainers, is highlighted to ensure optimal patient outcomes and care.

0Running head: LYMPHO-VENOUS INSUFFICIENCY
Lympho-venous Insufficiency
Student Name
University Name
Student Note

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Introduction
Lympho-venous insufficiency refers to the medical condition in which the extracellular
fluid accumulates, due to any trauma or damage of the lymph vessels and nodes. The
lymphatic system is known to aid in the filtration as well as the transportation of the
nutrient rich- lymph fluid consisting of serum protein, lymphocytes, other nutrient, and
waste products.
Thus, this condition creates a blockage in the lymphatic system, where the protein-rich
fluid tends to build up, resulting in the obstruction to the flow of the rest of the lymph
fluid. This is condition is characterized by swelling of the limbs- arms and legs, groin
area and mainly under the skin in the interstitial area and even fibrosis or hardening of
the skin (Crisóstomo & Armada-da-Silva, 2017).
Etiology:
Lymphedema can be divided into primary and secondary lymphedema. The primary
lymphedema is caused due to lympho-venous insufficiency or due to the congenital
aplasia or hypoplasia of the peripheral lymph nodes. The secondary lymphedema
occurs due to the formation of blockage in the lymph nodes causing disruption to the
flow of the interstitial fluid (Grada & Phillips, 2017).
This medical complication has been observed to arise, either due to the recurrent
incidence of infections like cellulitis, lymphangitis, or in cases of surgery, radiation
treatments, and incidence of cancer cell block in the vessels and nodes of the lymphatic
system (Piller, 2009). The infections and the cancer cell ‘blocks’, cause the increased
accumulation of either the pathogens or the abnormal production of the cancer cells,
inside the lymphatic nodes and vessels, resulting in the increased restriction of the flow
of the extracellular fluid (Padera, Meijer & Munn, 2016).
Pathophysiology:

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The functionality of the lymphatic system is to filter the waste and transport nutrients like
protein and lipids as well as water from the tissues to the vascular system. This system
is responsible for the boosting the functionality and efficacy of the immune system.
In cases of the incidence of diseases, the ability of the lymphatic system to filter and
transport nutrients, reduces, leading to the formation of excess amount of interstitial
fluid compared to the lymphatic return, which causes the stagnation and accumulation
of the heavy proteins in the interstitial space (Mendez et al., 2012). There can be an
increased retention and localization of water in thee interstitium, due to the surge in the
oncotic pressure.
Thus, in the interstitial space, the protein-rich fluid accumulates to generate an
inflammatory reaction, leading to the suppression in the functionality of the immunologic
reaction of that specific area.
The accumulation of the protein-rich interstitial fluid, can not only leads to the formation
of lymphatic edema but also can result in the valvular incompetence, leading to the
fibrosis of the lymphatic walls and spontaneous formation of the lymphatic shunts. This
causes the lymphatic nodes to harden and lose their ability to function properly.
Other than the infections and cancer cell formations, the most common risk factor of this
medical composition is any trauma or damage of the lymph nodes and vessels or
destruction of the tissues of a specific area (Padera, Meijer & Munn, 2016).
It has been observed that the in case of lympho-venous insufficiency leading to
lymphedema, the protein composition of the accumulated amount in the lymph nodes
and vessels gets modified. A reduction in the levels of alpha-2 globulin and a surge in
the albumin to globulin ratio have been seen to occur during medical cases like this.
This change can result in the further slowing down of the fluid transport and reduce the
effectiveness of the body’s immune system.
Prevalence:
In Australia, the prevalence of lympho-venous insufficiency is mainly observed in cancer
survivors who have undergone surgeries and chemotherapies. About 27% (9.4%

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women) of the cancer survivor population is seen to develop secondary lymphedema
(Hayes, 2011). An estimated amount of about 36%-47% of the vulva cancer, 20% of the
breast cancer, 24% of cervical cancer as well as 9%-29% of melanoma survivor
population in Australia, has been seen to develop lympho-venous insufficiency and
suffer from lymphedema. Even though tissue damages and surgeries are important risk
factors of the medical complication, the patients undergoing less invasive treatment
procedures like sentinel node biopsy, have been seen to suffer from a reduced
incidence of lymphedema (Gillespie, 2018).
Prognosis:
This medical condition is developed when the patient has had undergone major
surgeries, or procedures like chemotherapy, radiation or has suffered from trauma or
severe tissue damage. The best way to help reduce the swelling caused by the
restriction of the lymph fluid in the nodes is by employing non pharmaceutical means
like Complex decongestive therapy, compression garments, massage and exercises or
via pneumatic compression (Oshnari et al., 2016).

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Discussion
Provide an overview of management strategies (best practice) based on
classification and severity the presenting condition:
The main objective of treatment of the lympho-venous insufficiency or lymphedema is to
reduce the size of the pretentious limb and a development in the indications or signs of
patient and also to reduce or eliminate the re-occurring disease of those patients who
are suffering from them. There are certain therapies which have been developed to
deliver patients with improvement in their symptoms and reduce their affected portion.
These therapies have been classified into non-surgical (conservative) therapy and
surgical therapy. Maximum number of patient’s diagnosed lymphedema is managed by
non-surgical (conservative) therapy keeping the surgery as a secondary option for those
intractable to early conservative procedures or those that plateau at a unsatisfactory
level to the patient in spite of strict observance to firmness and manual lymphatic
drainage regimens (Garza et al., 2017).
Non-surgical management
There are various interventions under the non-surgical management strategies such as
the use of Diuretics during the early treatment of lymphedema, however usage of
diuretics for long term is not recommended.
There is another approach to manage the lymphedema which is referred as complex
lymphedema therapy, or complex decongestive therapy (CDT). This therapy is divided
into two categories - first is the reduction and the second is the maintenance which
consists of long duration management strategies.
CDT includes a manual lymphatic drainage (MLD) which is a type of compression
therapy, and other type of exercise and skin care as well as diverse range of movement
workout, inhalation and posture exercises also known as yoga, and education. MLD
consists of slow, repetitive stroking and circular massage arrangements done in a

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specific sequence. Compression therapy is used in concurrence with MLD (Garza et al.,
2017).
Surgical Measurement
Surgical treatment of lymphedema has been in use since a long time. This surgical
method helped in feeling up the gap in between the bridge of lymphatic obstruction and
to help establish a lymphatic conduit for egress of edema out of the affected extremity.
There are two physiologic mediations to treat lymphedema. One strategy is focused on
shunts being created between the congested lymph tubes and the venous system
proximal to the lymph barrier location. The other is based on the implementation to the
impacted extremity of vascularized soft tissue flaps that often include vascularized
lymph nodes (Garza et al., 2017).
Physiological techniques are intended to reduce the lymphatic fluid load in people with
lymphedema either by enhancing lymphatic circulation through the introduction of good
remote tissue into the impacted limb or by establishing an alternative outflow route for
lymphatic fluid.
The lymphedema can also be handled by using good lymph grafts from the lesser
severity to bypass upper arm lymphatics into good throat lymphatics across the torn
axillae of the upper extremities impacted (Garza et al., 2017).
Discuss the dermal clinician’s role in this and with particular focus on your
skincare recommendations (evidence based/ best practice):
Patients having lympho-venous impairment or lympho-venous insufficiency often face
serious skin issues which are associated with the build-up of interstitial fluid. While
improving the lympho-venous impairment it is necessary for the skin to be improved by
using both washes and leveon creams or ointments (White et al., 2014). While treating
a lympho-venous impairment a dermal clinician will suggest various kinds of therapies
to improve the skin conditions. There are certain therapies which can help in the
improvement of the skin condition. Such as Emollient therapy which is basically an
essential part for the treatment of eczema and other diseases that show symptoms on

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skin (White et al., 2014). Emollient therapy is a safe, effective treatment which uses
moisturizer, creams, and lotions to sooth dry skin (Pekyavaş et al., 2014). They are an
essential part for the successful treatment of the skin condition which may arise due to
eczema, psoriasis or lympho-venous insufficiency. Emollient consists of water and
lipids. The lipids create an occlusive layer on the skin which diminishes water loss from
the epidermis and enhances hydration. The elasticity and suppleness of the skin is
restored, helps in soothing the skin and reduces the scratchiness sensation. Emollient
therapy helps in restoring the normal obstruction function of the skin, inhibiting
infiltration of the bacteria and viruses. Since the skin acts as a microbial barrier; any
small break or cleave or any cuts can allow the infiltration of bacteria or viruses in the
protein filled lymph fluid. Skin treatments will help in the prevention of the infection and
will aim at keeping the skin at optimum condition (White et al., 2014). A patient should
always have a proper assessment of the skin which should be conducted a general
clinician or dermatologist to understand the cause of the dermatological condition
(Pekyavaş et al., 2014).
There are cases when patients have lympho-venous insufficiency as in chronic oedema,
which shows indications of abnormal levels of water and protein in the tissue (Gujja,
Sanina & Wiley, 2017). This can cause changes in the surface and subcutaneous level
of the skin. Washing the infected skin with an emollient and then applying cream or
emollient will help in prevention of worsening of the skin, and will inhibit the bacterial
and fungal manifestations. It will promote elimination of dead skin and improve drainage
of the superficial lymphatics. When compression is applied to the portion having the
oedema infection, it will help in reducing the tissue volume. This reduction in the volume
of tissue shows that the skin injury is recovering and getting back to its normal size
(Blake & Flynn, 2019).

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Conclusion
Thus, in conclusion, it can be see that mainly cancer survivors- patients undergoing
chemotherapy and surgeries have an increased incidence of lympho-venous
insufficiency and as a result often develop the medical condition of lymphedema.
Discussion On Inter Professional Management Considerations:
Thus, the best way to deal with lympho –venous insufficiency is by taking an inter-
professional approach. During the treatment of a patient suffering from lympho-venous
insufficiency, the patient would require to consult and undergo their treatment under a
lymphologist. The lymphologist will be able to understand the degree of degradation of
the patient’s lymphatic system, and implement the accurate treatment procedure to
ensure improve patient satisfaction (Matveev & Naumenko, 2010).
Nurses would require assisting the lymphologist carry out the clinical procedures
accurately. Their responsibility is to ensure that the patient is being accurately handled
and cared for, from the admission process up until their discharge. The nurses ensure
that the tests conducted, and medications prescribed are given to patient accurately at
the recommended time. They are to also communicate with the patients and ensure that
they are well informed about the medical procedures they will undergo.
It has been observed that obese people are more susceptible to the development of this
medical condition leading to lymphedema. Thus, for these patients, apart from the
nurses and the lymphologist, their treatment procedure would also require to include a
nutritionist as well as a physical trainer (Schmitz et al., 2009)
When the patient suffering from lympho-venous insufficiency, is found to have a high
BMI value, they should be suggested to visit a nutritionist who could help form an
accurate balanced diet plan incorporating low fat food items, in order to help the person,
reduce their weight. They should incorporate zinc supplements in their diet, which can
help boost the immune system and help in the healing process of the lymphedema.
Other than that, the patients are to be recommended to maintain a balanced protein and

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carbohydrate intake, which can help in improving the patient’s lymphatic health (Greene,
2015).
Another professional that can help the patient significantly lose their weight are physical
trainers. They are to accurately formulate a well-structured and customized exercise
routine, keeping in mind the medical history as well as the age and physical capacity of
the patient (Seidel et al., 2015).
Considering that this disease is highly incident in cancer survivors, the involvement of
the healthcare professionals caring for the patient in any post-chemotherapy or post-
surgery rehabilitation centers, is highly crucial to accurately understand the current
medical condition of the patient (Ohba et al., 2011). Consulting them would help the
nurses understand the current mental condition of the patient, which will lead to
improved handling of the patient. They can further provide detailed lists of the recent
prescribed medications, which the lymphologist will require to keep in mind during
prescribing medications for this condition.
The lymphologist might require to consult the associated oncologist, in order to
understand the mental as well as physical condition of the patient and also to get an
insight on the reason behind the development of the lympho-venous insufficiency.
Considering the age of the patient or their ability to physically exert themselves, the
patients might be recommended to undergo complete decongestive physical therapy to
ensure the reduction of the swelling and provide increased relief.
Lastly, the involvement of pharmacists in the healthcare facility is crucial to ensure that
the prescribed dose is available in the facility, in order to be administered to patient
timely and accurately.
Thus, to ensure that the patient is provided with effective treatment, the active
participation and involvement of these professionals are crucial.

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