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Author: Stephanie Phan, Sylvia Crowhurst, Pam HammondCreated: 02/2016Form: D-8605

For patients with upper body lymphedema who have had treatment for cancer (breast, melanoma, sarcoma, lymphoma) including:• Removaloflymphnodes• Radiation

This pamphlet explains:• Whatisself-bandaging• Howdoesbandaginghelpwithlymphedema• WhenshouldIwearthebandages• WhatshouldIdobeforeIbandage• Howtobandageyourfingersandarms

Disclaimer:Thispamphletisforpatientswithlympedema.Itisonlytobeusedafterthepatientand/orfamilymemberhasbeentaughthowtobandagebyaclinicianatthePrincessMargaretCancerCentreLymphedemaClinic.

Howtoself-bandageyourhand(s)andarm(s)toreducelymphedema(swelling)

PrincessMargaret

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Do not self-bandage if you have an infection in your fingers, hand, arm, trunk or chest:

Signsofinfectionmayinclude:• Rednessoftheskinthatexpandsorspreads.• Feelingofheatorwarmthintheareathatisred.• Painintheareathatisred.• Raisedskinaroundtheareathatisred.• Feverorchills.Normalbodytemperatureis:98.6°For37°• Feelingsickorunwell.

If you think you have an infection, go to • YourFamilyDoctor• WalkinClinic• Ifnowalk-inclinicisopen,gototheclosesthospitalEmergencyDepartment

Ifyoudohaveaninfection,itisimportanttogetmedicalhelprightawaybecauseinfectionscanspreadquickly.Ifyouhaveaninfectionorothermedicalconcerns,askyourhealthcareprofessionalifyoushouldkeepbandaging.

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What is the lymphatic system? • Yourlymphaticsystemremovesextrafluidandwastefromyourbody.

• Yourlymphaticsystemplaysanimportantroleinhowyourimmunesystemworks.

• Yourlymphaticsystemismadeupoflymphnodesthatarelinkedbylymphvessels.

Yourlymphnodesarebeanshapedorgansthatarefoundalloveryourbody.Largegroupsoflymphnodescanbefoundinyourneck,underyourarmsandinyourgroin(seepicturetotheright).

Lymphnodescanberemovedaspartofcancertreatment.Thiscancauseatypeofswellingthatiscalledlymphedema.

The Lymphatic SystemCirclesshowwheregroupsoflymphnodesareinyourbody.

What is self-bandaging?Self-bandagingisawaytohelptreatlymphedema(swelling).Self-bandagingisbandagingthatyoudobyyourselforwiththehelpofafamilymemberorfriend.Self-bandagingiswhenmanylayersofpaddingandbandagesarewrappedaroundtheswollenareaofyourbodytomakeasoftcast.

How does bandaging help with lymphedema?Ifyouhadlymphnodesremovedunderyourarm(s)and/orradiationtreatmentunderyourarm(s),breast,chestortrunk,theareasthatmayhaveswellingmayincludeyourfinger(s),hand(s),arm(s),breast(s),andchest.

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Wrappingtheswollenpartofyourbodywithbandages(compression),helpsmovethelymphfluidinthedirectionoftheheartandawayfromyourswollenarea.

Thegoalofbandagingisto:• helpreducetheswelling• helppreventtheswellingfromgettingworse

When should I wear the bandages?Ifyouhavelymphedema,youshould:

• Wearyourbandagesduringthedayandwhenyouexercise.

• Wearyourbandagesforafewhoursaday.Slowlyincreasetheamountoftimeyouwearthemduringtheday.Thiswillhelpyougetusedtowearingthebandages.

• Begintowearyourbandagesatnightafteryoufeelcomfortablewearingthebandagesduringtheday.Itisimportantthatthebandagesfeelcomfortablebeforeyoutrysleepinginthemallnight.

• Ifyouwearthebandagesduringthedayandnight,remembertotakeyourbandagesoffeachdaytotakecareofyourskin.Takeabathorshowerandcheckyourskinforcutsandredness.Putmoisturizer(lotion)onyourskin.Remembertoletthemoisturizersoakintoyourskincompletelybeforeyoubandage.

• Wrapthebandagesagainiftheysliporbecomeloose.Itisnormalforbandagestoslipwhenyouaremoving.

• Beawareofyourbody.Ifthebandagesbecomeuncomfortable,tryremovingthemandre-bandaging.Iftheyarestilluncomfortableafteryoure-bandage,contactthePrincessMargaretLymphedemaClinicat4169464501ext.2363.

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What should I do before I bandage?

• Cleanyourskinwithsoapandwaterandpatitdry.Makesureyoudrybetweenyourfingers.

• Checkyourskinforanycutsorredness.Ifneeded:

• Cleanthecutandapplyabandaid.Thenexttimeyoutakeyourbandagesoff,checktoseeifthecutishealingandtherearenosignsofinfections(Seepage2forthesignsofinfection).

• Ifthecutisstillred,theareamaybeinfected.Getmedicalhelp(Seepage2).

• Putskinlotiononyourskin.Thiswillkeepyourskinmoistandhelpyouavoiditchiness,irritationandblisters.

• Applyskinlotiontoyourarmandhand.

• Rubitintoyourskinsothatyourskinismoistbutnotsticky

• Pullonthestockinette(Seeimageonpage8).Itwillpreventthelotionfromrubbingoff.

Makesureyouareinacomfortablepositionwhilebandagingtoavoidanybackorshoulderdiscomfort.

Follow instructions given by the staff at the Lymphedema Clinic.

If you lose your self-bandaging instructions, contact the Lymphedema Clinic at 416-946-4501 ext. 2363. The clinic will mail or email you another copy.

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Have all your supplies ready before you begin

Bandagingsuppliesmayinclude:

• Stockinette(tubularcotton)toprotectthehandandarm

• Padding(softwhiteartiflex/castorpaddingorfoam)tohelpwithpressureofthebandages

• Gauze(white,4cmand/or6cm)bandageforyourfingersandthumb

• Short stretch bandages(beige)6cm,8cmor10cm

• Optional: Adhesive (sticky) gauzeforyourfingersandthumb(Seepage9)

Askforourbookleton“HowtoCareforYourBandages”

How to Bandage Your Fingers and ArmsTherearethreestepstofollow:Step1:BandageyourfingersStep2:WrappaddingonyourhandandarmStep3:Bandageyourhandandarm

Soft padding

Short stretchbandages

Foam padding

Gauze for fingers

Stockinette

Adhesivegauze

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Step 1. Bandage your fingers

• Putthestockinetteonyourarm.• Thestockinettewillcoveryourhandbutnotyourfingersandstopjustbelowyourunderarm(aboutthesizeof2fingerswidebelowyourunderarm).

• Cutasmallholeinthestockinetteforyourthumb

• Pullthestockinettebackoveryourhandandwristtobandageyourfingersandthumb

• Wrapeither4or6cmgauzearoundyourwrist.

• Wrapyourthumbfirst.Bringthegauzeuptowardsthebottomofyourthumbnail.

• Startfromthebottomofyourthumbnailandwraparoundyourthumbtwoorthreetimestowardsthebaseofyourthumb.

• Do not pull the gauze tightasyoubandageyourthumbandfingers.

• Wrapthegauzearoundyourwristagain

Stockinette

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• Continuewrappingeachfingerthesameway

• Afteryouhavewrappedallthefingersandthumbwithgauze,wrapthebaseofeachfingerandthumb.Youmayhaveenoughgauzelefttodothisoryoumayneedtouseanotherrollofgauze.

• Wrapthegauzearoundyourwristandbringthegauzearoundthebaseofyourthumbandbackaroundthewrist.Thisisa“figure8”pattern.

• Continuewrappingthebaseofeachfingerthesameway.Thiswillhelpsecurethefingerbandages.

• Ifyouhaveanyextragauze,wrapitoverthewristandarm.Donotcutthegauze.

• Pullthestockinettebackoveryourwristandhandandputyourthumbinthethumbholeyoucutinstep1.

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Option: FingerWrapwithAdhesive(sticky,gluebased)gauze.

Youcanuseadhesive(stickyorglue-based)gauzetobandageyoureachfingerandthumbonitsownifyouprefer.• Wrapeachfingerandyourthumbwithoutpullingthegauze

Whenyouhavefinishedyourbandagingyourfingers,checkyourbloodflowbydoingthefollowingtest:• Pressonyourfingernail.Itshouldlosesomecolourorturnpale.

• Thecolourwillreturnafterafewsecondswhenyoureleasethefinger.

• Ifthisdoesnothappenyoumayhavebandagedtootightly.Youwillneedtoremovethebandageandwrapmoreloosely.

The finger bandages should feel comfortable. You should not feel pain or discomfort.

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Step 2. Wrap padding on your hand and arm

• Youcanusethefluffyorfoampaddingforthisstep.• Withthe10cmpadding:Wraparoundyourhandbeginningatthebaseofthefingers.Youmaywanttocutasmallholeinthepaddingforyourthumbsothepaddingfitsaroundyourhandeasily.

• Wraparoundthepalmofthehandmovingclosertothewrist.Coverthewholehand.

• Overlapthepaddingbyhalfwitheachwrap.

• Continuewiththispaddingupthearminthesameway

• Continuetowrapthepaddingtojustbelowyourunderarm(abouttwofingerswidthsbelowunderarm)

• Trytosmoothoutthewrinklesinthepaddingasbestyoucan.Donotusetapeasitmaytearthepadding

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Step 3. Bandage your hand and arm

Youmayneedthreebandagesforthisstep:Bandage#1:a6cmbandage(beige)Bandage#2:a8cmbandage(beige)Bandage#3:a8cmor10cmbandage(beige)

Bandage #1 – 6 cm bandage (beige)

• Keepyourfingersspreadwhenyouwrapyourhand.Thiswillallowyourfingerstomovefreelywhenyourhandisbandaged.

• Beginwiththe6cmbandage(beige).Wraparoundyourwristoncewithout pulling.Thiswillsecurethebandage.

• Pullthebandageacrossthetopofyourhandtothebaseofyourfinger(knuckle)wraptwotothreemoretimes,pullingthebandageacrossthetopandacrossthepalmofyourhand

• Nowwrapthebandagearoundyourwristandbackaroundyourhandtwoorthreetimes.Thisis“figure8”pattern.

• Giveagentlepullonthebandageateachhalfturntokeepanevenpressure.

• Wrapthebandageclosetoyourthumboverthepalmofyourhand.

• Giveagentlepullonthebandageateachhalfturntokeepanevenpressure.

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• Makeafistwithyourhandwhenyoubeginbandagingtheforearm(wristtoelbow).Thismakesthemusclesinyourforearmtightandwillstopthebandagesfromcausingextrapressurewhenyoumoveupthispartofyourarm.

• Continuewiththesamebandageupthearm.• Overlapthebandagebyhalfwitheachwrap.• Alwaysgiveagentlepullonthebandageateachhalfturntokeepanevenpressure.

• Tapetheendofthebandagetostopitfromgettingloose.

Bandage #2 – 8 cm bandage (beige)

• Takean8cmbandage.Wrap around the wrist once without pulling.Thiswillmakeitsecure.

• Makeafistwithyourhandwhenyouwrapyourforearm.Continuetowrapthisbandageupyourforearm

• Overlapthebandagebyhalfwitheachwrap.• Giveagentlepullonthebandageateachhalfturntokeepanevenpressure.

• Continuewiththesamebandage.Whenyoureachtheelbow,bendyourelbowslightly.

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• Wrapthebandageover the elbow.• Thenwrapthebandage below the elbow.• Thenfinallywrapabove the elbowinafigure8pattern.

• Makesurethepaddingdoesnotshowthroughattheelbow.Bendyourelbowfullytocheckthatthebandagecoversthepadding.

Itisveryimportantthatthebandagecoversthepaddingcompletely.Ifthebandagedoesnotcoverthepadding,thatpartofyourarmisnotgettingcompression(pressure)andmaybecomemoreswollen.Ifyoucanseethepadding,takeoffthebandageandre-wrapitasabove.• Continuewrappingtheupperarm• Overlapthebandagebyhalfwitheachwrap.• Giveagentlepullonthebandageateachhalfturntokeepanevenpressure.

• Tapetheendofthebandagetopreventitfromgettingloose.

Bandage #3 – 8 or 10 cm bandage (beige)

• Thethirdbandagecanbe8cmor10cm.Starttowrapthisbandageatthemiddleofyourforearm.Thisbandageshouldcomeallthewayupyourarm.

• Wrap in the opposite direction to the previous bandage.

• Wrapthebandagearoundyourforearmoncewithoutpulling.Thiswillsecurethebandage.

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• Continuewrappingupyourarm.• Overlapthebandagebyhalfwitheachwrap.• Dothefigure8wrapoveryourelbow(asdescribedbefore).Thiswillhelpwithelbowmovement.

• Alwaysgiveagentlepullonthebandageateachhalfturntokeepanevenpressure.

• Continuewrappingtothetopofyourarmtojustbelowyourunderarmandtapetheendofthebandagetopreventitfromgettingloose.

Whenyoufinishbandagingyourarm,checkyourbloodflowbydoingthefollowingtest.• Pressonyourfingernail.Itshouldlosesomecolourorturnpale.

• Thecolourwillreturnafterafewsecondswhenyoureleasethefinger.

Ifthisdoesnothappenyoumayhavebandagedtootightly.Youwillneedtoremovethebandageandwrapmoreloosely.

The arm wrap should feel comfortable. You should feel no pain or discomfort.

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What should you avoid?• Donotstrainyourshoulders,neck,armorhand.• Donotwrapthebandageinawaythatcausesyoupain.• Donotcontinuetoself-bandageifitcausesyoupain.Ifyoufeelpaincallyourdoctororhealthcareteam.

• Donotself-bandageifyouhaveaninfectionintheareathathasswelling.

Follow instructions given by the staff at the Lymphedema Clinic.

Contact informationIfyouhavequestionsaboutself-bandaging,contacttheSurvivorshipClinicat416-946-4501extension2363.Asktospeakwithoneofthehealthcareteamaboutself-bandaging.

ThedevelopmentofpatienteducationresourcesissupportedbythePrincessMargaretCancerFoundation.