Wound Care

184 Nurse to Nurse
KEY POINTS
• Lymphedema is different from venous insufficiency and requires
different treatment.
• There are different types of lymphedema.
• Lymphedema treatment is through management, as it cannot be cured.
ANATOMY AND PHYSIOLOGY
The lymphatic system is a one-way fluid transport system. Its
capillaries receive excess interstitial fluid, proteins, cellular
debris or dead cells, toxins, cancer cells, fats, and bacterial
products associated with inflammation or infection. These capillaries
merge into lymphatic vessels and this fluid is filtered by
lymph nodes. The lymphatic system finally joins with the
venous system at the thoracic duct. 1
In the body, the net forces that drive fluid into capillaries
must equal the force causing outward movement to maintain
compartmental fluid balance; however, there is actually a disequilibrium
that favors the outward flow of fluid.
The lymphatic capillaries are responsible for removing this
extra fluid in the interstitial space. One half of total blood protein
and 1 to 2 liters of water escape from the blood into the tissues
every day to be returned by the lymphatic system.
Lymphedema occurs when fluid (water) and proteins accumulate,
and the lymphatic system is unable to mechanically
remove them.
Key Definitions
Tissue fluid: fluid outside the blood and lymph vessels and
capillaries.
Plasma: nonclotting fluid that makes up more than one-half
of the blood; 90% water and 10% suspended particles (proteins,
inorganic particles, organic substances) represents 20% of
extracellular fluid volume.